PRAIRIE VILLAGE SUPPORTIVE LIVING LLC (NPI# 1518339167) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518339167 |
| Entity Type | Organization |
| Organization Name | PRAIRIE VILLAGE SUPPORTIVE LIVING LLC |
| Practice Address |
200 International Drive Rantoul IL 61866 |
| Practice Telephone | 2178922800 |
| Practice Fax Number | 2178922833 |
| Mailing Telephone | 2178922800 |
| Mailing Fax Number | 2178922833 |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-11-03 |
| Authorized Official Name | JOELLEN BLEAVINS (VICE PRESIDENT OF MANAGEMENT AGENT) |
| Authorized Official Telephone | 8159351992 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRAIRIE VILLAGE SUPPORTIVE LIVING LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities | ||
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
200 INTERNATIONAL DRIVE |
| City | RANTOUL |
| State | IL |
| Zip Code | 61866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245489855 | Preferred Care LLC | Assisted Living Facility | 200 International Drive, Rantoul, IL 61866 | 2008-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831411941 | Erin Christine Kelly | Speech-Language Pathologist | 722 Stonebridge Center Rd, Rantoul, IL 61866 | 2010-02-17 |
| 1114175577 | Robert Foy Robinson | Dentist | 700 E Grove Av, Dr Robert F. Robinson, Rantoul, IL 61866 | 2008-08-28 |
| 1093911927 | Wal-mart Stores, Inc. | Technician/Technologist | 416 S Murray, Rantoul, IL 61866 | 2007-06-26 |
| 1790700110 | Bruce W Kaplan | Family Medicine | 1540 E. Grove Street, Rantoul, IL 61866 | 2006-07-13 |
| 1922455302 | Rosecrance Inc | Clinic/Center | 1300 Crane Ave, Rantoul, IL 61866 | 2016-05-16 |
| 1548347263 | Naser Jahanbiglar | Physician Assistant | 1540 E. Grove Street, Rantoul, IL 61866 | 2006-11-01 |
| 1609895499 | Thomas L Franzen | Family Medicine | 1540 E. Grove Street, Rantoul, IL 61866 | 2006-07-19 |
| 1841833100 | April M Bailey | Pharmacy | 1019 Oakcrest Dr, Rantoul, IL 61866-1118 | 2019-10-18 |
| 1740897412 | Angela Perry | Developmental Therapist | 521 Eden Park Dr, Rantoul, IL 61866-1507 | 2020-09-28 |
| 1639735145 | Tasha Howard | Social Worker | 516 Eden Park Dr, Rantoul, IL 61866-1508 | 2019-05-10 |
| Find all providers in zip 61866 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245489855 | Preferred Care LLC | Assisted Living Facility | 200 International Drive, Rantoul, IL 61866 | 2008-09-18 |
| 1396133658 | Wc- Rantoul Ops, LLC | Assisted Living Facility | 300 Twin Lakes Dr, Rantoul, IL 61866-2663 | 2015-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871190504 | The Manor At Jerseyville Glen, Lp | Assisted Living Facility | 904b Estates Dr, Jerseyville, IL 62052-2377 | 2020-10-06 |
| 1861008872 | Franciscan Communities, Inc. | Assisted Living Facility | 15624 Marian Dr, Homer Glen, IL 60491-6271 | 2020-09-16 |
| 1447865118 | Oakley Courts Assisted Living Community | Assisted Living Facility | 3117 W Kunkle Blvd, Freeport, IL 61032-6943 | 2020-09-10 |
| 1083233076 | Marley Oaks Assisted Living Residence | Assisted Living Facility | 12631 187th St, Mokena, IL 60448-8731 | 2020-04-10 |
| 1447884630 | Cedarhurst of Quincy Operator, LLC | Assisted Living Facility | 319 S 48th St, Quincy, IL 62305-0593 | 2020-02-26 |
| 1164055323 | Cye Sullivan Hco, LLC | Assisted Living Facility | 20 Courtyard Blvd, Sullivan, IL 61951-7001 | 2020-02-17 |
| 1255964573 | Cottages At Salem, Inc. | Assisted Living Facility | 339 S Hotze Rd, Salem, IL 62881-6858 | 2020-02-14 |
| 1841821014 | Generations At Oakton Arms, LLC | Assisted Living Facility | 1665 Oakton Pl, Des Plaines, IL 60018-6301 | 2020-01-28 |
| 1710521984 | Cottages At Carlinville, Inc | Assisted Living Facility | 18804 Rt. 4, Carlinville, IL 62626 | 2019-10-31 |
| 1275184889 | The Encore At The Twin Cities | Assisted Living Facility | 101 N Wacker Dr Ste 608, Chicago, IL 60606-1726 | 2019-09-25 |
| Find all providers with the same taxonomy | ||||
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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.