LTC OF ILLINOIS - FIRESIDE, INC.


Address: 1030 Martin Luther King Dr, Centralia, IL 62801-3002
Phone: 6185321833

LTC OF ILLINOIS - FIRESIDE, INC. (NPI# 1700819778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1700819778
Entity Type Organization
Organization Name LTC OF ILLINOIS - FIRESIDE, INC.
Other Organization Name FIRESIDE HOUSE OF CENTRALIA
Practice Address 1030 Martin Luther King Dr
Centralia
IL 62801-3002
Practice Telephone 6185321833
Practice Fax Number 6185321308
Mailing Telephone 6185321833
Mailing Fax Number 6185321308
Enumeration Date 2006-07-10
Last Update Date 2008-04-20
Authorized Official Name DOUGLAS K MITTLEIDER (PRESIDENT)
Authorized Official Telephone 7706190866
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 314000000X Skilled Nursing Facility 0045690 IL Nursing & Custodial Care Facilities

Other Provider/Organization Names

Other Name Type Code
Fireside House of Centralia Doing Business As Name - Organization

Office Location

Street Address 1030 MARTIN LUTHER KING DR
City CENTRALIA
State IL
Zip Code 62801-3002

Providers in the same location

NPI Name Taxonomy Address Enumeration
1861977019 Hcc-healthcare Properties, LLC Skilled Nursing Facility 1030 Martin Luther King Dr, Centralia, IL 62801-3002 2018-10-03
1346526134 Fireside-ltc, LLC Skilled Nursing Facility 1030 Martin Luther King Dr, Centralia, IL 62801-3002 2011-10-25

Providers in the same zip code

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 Information

Taxonomy Code 314000000X
Grouping Nursing & Custodial Care Facilities
Classification Skilled Nursing Facility

Taxonomy Definition

(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.

Providers in the same taxonomy and city

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
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
1912305202 Fmg Alexander Street Washington LLC Skilled Nursing Facility 1305 Alexander St, Centralia, WA 98531-1305 2014-12-18
Find all providers in CENTRALIA

Competitor

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City CENTRALIA
Zip Code 62801

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Dataset Information

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.

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