FIRESIDE-LTC, LLC (NPI# 1346526134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346526134 |
| Entity Type | Organization |
| Organization Name | FIRESIDE-LTC, LLC |
| Other Organization Name | FIRESIDE HOUSE OF CENTRALIA |
| Practice Address |
1030 Martin Luther King Dr Centralia IL 62801-3002 |
| Mailing Address |
10945 State Bridge Rd Suite 401-470 Alpharetta GA 30022-8164 |
| Practice Telephone | 6785222436 |
| Practice Fax Number | 7706634539 |
| Mailing Telephone | 6785222436 |
| Mailing Fax Number | 7706634539 |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-11-10 |
| Authorized Official Name | MR. DAREN G DOUSTON (MEMBER CFO) |
| Authorized Official Telephone | 6785222436 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Fireside House of Centralia | Doing Business As Name - Organization |
| Street Address |
1030 MARTIN LUTHER KING DR |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700819778 | Ltc of Illinois - Fireside, Inc. | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2006-07-10 |
| 1861977019 | Hcc-healthcare Properties, LLC | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2018-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568748317 | Friendship-ltc, LLC | Skilled Nursing Facility | 1000 Martin Luther King Dr, Centralia, IL 62801-3002 | 2011-10-25 |
| 1962435941 | Ltc Illinois - Friendship, Inc. | Skilled Nursing Facility | 1000 Martin Luther King, Centralia, IL 62801 | 2006-07-10 |
| 1700819778 | Ltc of Illinois - Fireside, Inc. | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2006-07-10 |
| 1194763565 | Sharon Care Center, Inc | Skilled Nursing Facility | 1509 Harrison Ave, Centralia, WA 98531-4568 | 2006-06-04 |
| 1245227131 | Northwest Country Place, Inc | Skilled Nursing Facility | 917 S Scheuber Rd, Centralia, WA 98531-9027 | 2005-10-05 |
| 1689660961 | Unlimited Development Inc. | Skilled Nursing Facility | 1910 E Mccord, Centralia, IL 62801-6586 | 2005-09-22 |
| 1942295993 | Evergreen Washington Healthcare Centralia, L.L.C. | Skilled Nursing Facility | 1015 Long Rd, Centralia, WA 98531-1038 | 2005-09-15 |
| 1154328953 | Health Services Administration, Inc | Skilled Nursing Facility | 750 E Highway 22, Centralia, MO 65240-1146 | 2005-07-07 |
| 1861977019 | Hcc-healthcare Properties, LLC | Skilled Nursing Facility | 1030 Martin Luther King Dr, Centralia, IL 62801-3002 | 2018-10-03 |
| 1134632961 | Riverside Nursing - Centralia LLC | Skilled Nursing Facility | 1305 Alexander St, Centralia, WA 98531-1305 | 2017-11-15 |
| Find all providers in CENTRALIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.