BEVERLY ENTERPRISES - ILLINOIS, INC. (NPI# 1699868257) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699868257 |
| Entity Type | Organization |
| Organization Name | BEVERLY ENTERPRISES - ILLINOIS, INC. |
| Other Organization Name | BLU FOUNTAIN MANOR |
| Practice Address |
1623 W. Delmar #29 Godfrey IL 62035 |
| Practice Telephone | 6184660443 |
| Mailing Telephone | 6184660443 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DAVID MERRELL (VICE PRESIDENT) |
| Authorized Official Telephone | 4792014840 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 105286 | 01 |
| IL | GROUP HP | 53511 | 01 |
| Other Name | Type Code |
|---|---|
| Blu Fountain Manor | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265526818 | Beverly Enterprises - Illinois, Inc. | Skilled Nursing Facility | 107 S. Lincoln, Smithton, IL 62285 | 2006-10-03 |
| 1275628448 | Beverly Enterprises - Illinois, Inc. | Skilled Nursing Facility | 393 E Edwardsville Rd, Wood River, IL 62095-1646 | 2006-10-04 |
| Street Address |
1623 W. DELMAR #29 |
| City | GODFREY |
| State | IL |
| Zip Code | 62035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548775109 | Bethany E Huelskoetter | Nurse Practitioner | 6702 Godfrey Road, Godfrey, IL 62035 | 2017-12-05 |
| 1720448806 | Sarah Gieszelmann | Nurse Practitioner | 5520 Godfrey Rd Ste B, Godfrey, IL 62035 | 2016-03-02 |
| 1629457536 | Callie Ann Feldman | Occupational Therapy Assistant | 1373 D'adrian Professional Park, Godfrey, IL 62035 | 2015-05-26 |
| 1962767038 | Win U Care for Health | Dietetic Technician, Registered | 321 Big Arch Rd., Godfrey, IL 62035 | 2012-07-05 |
| 1790049831 | Julia Lynn Phillips | Dietetic Technician, Registered | 321 Big Arch Rd, Godfrey, IL 62035 | 2012-07-03 |
| 1578729810 | Home and Environments for Living and Programs | Intermediate Care Facility, Mentally Retarded | 110 N Alby Court, Godfrey, IL 62035 | 2008-08-06 |
| 1497960777 | Joanne T Schulmeister | Dentist | 1203 West Delmar, Godfrey, IL 62035 | 2007-05-11 |
| 1760522965 | Lori Behrens | Social Worker | 5090 Humbert Road, Godfrey, IL 62035 | 2007-02-07 |
| 1326147802 | Kymberly Barnard | Speech-Language Pathologist | 6501 Timber Ridge Ln, Godfrey, IL 62035 | 2006-09-21 |
| 1588102339 | Sarah Margaret Herrin | Occupational Therapy Assistant | 1373 D'adrian Professional Park, Godfrey, IL 62035 | 2017-02-01 |
| Find all providers in zip 62035 | ||||
| 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 |
|---|---|---|---|---|
| 1962613828 | Godfrey Healthcare & Rehabilitation Center LLC | Skilled Nursing Facility | 1623 W Delmar Ave, Godfrey, IL 62035-1317 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413537 | Citadel of Glenview LLC | Skilled Nursing Facility | 1700 E Lake Ave, Glenview, IL 60025-2003 | 2020-09-28 |
| 1598379075 | Patient Builders Marketing | Skilled Nursing Facility | 800 W Army Trail Rd, Carol Stream, IL 60188-9040 | 2020-09-02 |
| 1730790817 | Ih Fox Valley Opco, LLC | Skilled Nursing Facility | 4020 E New York St, Aurora, IL 60504-4416 | 2020-08-12 |
| 1902428147 | Aperion Care Glenwood LLC | Skilled Nursing Facility | 19330 South College Grove, Glenwood, IL 60425 | 2020-05-11 |
| 1487273330 | Residential Alternatives of Illinois, Inc | Skilled Nursing Facility | 2203 Flagg Rd, Rochelle, IL 61068 | 2020-04-10 |
| 1932728003 | Tco Jv, LLC | Skilled Nursing Facility | 550 Ridgeview Drive, Mchenry, IL 60050 | 2020-04-09 |
| 1841825510 | Ih Lisle Opco, LLC | Skilled Nursing Facility | 2850 Ogden Avenue, Lisle, IL 60532 | 2020-03-03 |
| 1114550381 | Rosiclare Hco, LLC | Skilled Nursing Facility | 55 Ferrell Rd, Rosiclare, IL 62982-1006 | 2020-02-17 |
| 1225672033 | All Ways Caring Services, Inc. | Skilled Nursing Facility | 301 N Neil St Ste 301, Champaign, IL 61820-3167 | 2019-11-05 |
| 1578036695 | Heartland Nursing & Rehabilitation LLC | Skilled Nursing Facility | 410 Nw 3rd St, Casey, IL 62420-1014 | 2019-01-11 |
| 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.