CARAVILLA RESIDENTIAL CENTERS, INC (NPI# 1659363661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659363661 |
| Entity Type | Organization |
| Organization Name | CARAVILLA RESIDENTIAL CENTERS, INC |
| Other Organization Name | CASEY CARE CENTER |
| Practice Address |
5 Doctors Park Rd Mount Vernon IL 62864-6224 |
| Practice Telephone | 6182421064 |
| Practice Fax Number | 6182427559 |
| Mailing Telephone | 6182421064 |
| Mailing Fax Number | 6182427559 |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL F FLANAGAN (CORPORATE ATTORNEY) |
| Authorized Official Telephone | 8164440900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 0039800 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| CASEY CARE CENTER | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184616195 | Caravilla Residential Centers, Inc | Nursing Facility/Intermediate Care Facility | 1717 Jefferson Ave, Mount Vernon, IL 62864-4330 | 2005-08-16 |
| 1932109485 | Caravilla Residential Centers, Inc | Skilled Nursing Facility | 1700 White St, Mount Vernon, IL 62864-4349 | 2005-07-27 |
| Street Address |
5 DOCTORS PARK RD |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-6224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639687395 | Amanda Jo Porter | Occupational Therapist | 5 Doctors Park Rd, Mount Vernon, IL 62864-6224 | 2018-01-16 |
| 1780767897 | Petersen Management Company, LLC | Nursing Facility/Intermediate Care Facility | 5 Doctors Park Rd, Mount Vernon, IL 62864-6224 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447317235 | Levering Management Inc. | Nursing Facility/Intermediate Care Facility | 1076 Coshocton Ave, Mount Vernon, OH 43050-1474 | 2007-01-02 |
| 1316993355 | Oak Health Care Investors of Mt Vernon, Inc. | Nursing Facility/Intermediate Care Facility | 13 Avalon Rd, Mount Vernon, OH 43050-1403 | 2006-05-25 |
| 1184616195 | Caravilla Residential Centers, Inc | Nursing Facility/Intermediate Care Facility | 1717 Jefferson Ave, Mount Vernon, IL 62864-4330 | 2005-08-16 |
| 1780767897 | Petersen Management Company, LLC | Nursing Facility/Intermediate Care Facility | 5 Doctors Park Rd, Mount Vernon, IL 62864-6224 | 2006-10-23 |
| 1659471993 | Petersen Health Care Ll, Inc. | Nursing Facility/Intermediate Care Facility | 1717 Jefferson Ave, Mount Vernon, IL 62864-4330 | 2006-09-25 |
| 1669471264 | The Ohio Eastern Star Home, Inc | Nursing Facility/Intermediate Care Facility | 1451 Gambier Rd, Mount Vernon, OH 43050-9112 | 2005-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386094068 | Icg Home Health | Nursing Facility/Intermediate Care Facility | 4508 Camden Ct, Richton Park, IL 60471-1147 | 2016-06-14 |
| 1871999078 | Midwest Health Operations LLC | Nursing Facility/Intermediate Care Facility | 3601 16th Ave, Sterling, IL 61081-4059 | 2014-11-15 |
| 1437410891 | Mado Healthcare | Nursing Facility/Intermediate Care Facility | 1541 North Wells, Chicago, IL 60610-1307 | 2012-06-01 |
| 1134405392 | Faith Community Health Services, Inc | Nursing Facility/Intermediate Care Facility | 4449 177th St, Country Club Hills, IL 60478-4705 | 2011-11-01 |
| 1215188487 | Petersen Health Care, Inc | Nursing Facility/Intermediate Care Facility | 144 Jounior Ave., Kewanee, IL 61443 | 2008-10-07 |
| 1699936054 | Pinckneyville Healthcare Center | Nursing Facility/Intermediate Care Facility | 708 Virginia Ct, Pinckneyville, IL 62274-1538 | 2008-06-18 |
| 1184894412 | Parents and Friends of The Slc-home 1 | Nursing Facility/Intermediate Care Facility | 3 Gundlach Pl, Swansea, IL 62226-4227 | 2008-03-03 |
| 1740463074 | St. Joseph's Home of Springfield | Nursing Facility/Intermediate Care Facility | 3306 S 6th Street Rd, Springfield, IL 62703-4735 | 2007-12-10 |
| 1821283573 | Royal Living Center Inc | Nursing Facility/Intermediate Care Facility | 200 South 9th Street, New Baden, IL 62265 | 2007-09-06 |
| 1235323841 | Parents and Friends of Slc | Nursing Facility/Intermediate Care Facility | 1450 Caseyville Ave, Swansea, IL 62226-4517 | 2007-08-28 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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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.