CARAVILLA RESIDENTIAL CENTERS, INC (NPI# 1932109485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932109485 |
| Entity Type | Organization |
| Organization Name | CARAVILLA RESIDENTIAL CENTERS, INC |
| Other Organization Name | JEFFERSONIAN HEALTH CARE |
| Practice Address |
1700 White St Mount Vernon IL 62864-4349 |
| Practice Telephone | 6182424075 |
| Practice Fax Number | 6182424092 |
| Mailing Telephone | 6182424075 |
| Mailing Fax Number | 6182424092 |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHAEL F FLANAGAN (RECEIVER FOR, CORPORTATE ATTORNEY) |
| Authorized Official Telephone | 8164440900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 0039818 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| JEFFERSONIAN HEALTH CARE | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659363661 | Caravilla Residential Centers, Inc | Nursing Facility/Intermediate Care Facility | 5 Doctors Park Rd, Mount Vernon, IL 62864-6224 | 2005-08-16 |
| 1184616195 | Caravilla Residential Centers, Inc | Nursing Facility/Intermediate Care Facility | 1717 Jefferson Ave, Mount Vernon, IL 62864-4330 | 2005-08-16 |
| Street Address |
1700 WHITE ST |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-4349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609385327 | Chelsea Jo Beaty | Speech-Language Pathologist | 1700 White St, Mount Vernon, IL 62864-4349 | 2017-09-26 |
| 1487034526 | Katie Maberry | Speech-Language Pathologist | 1700 White St, Mount Vernon, IL 62864-4349 | 2015-06-03 |
| 1114323656 | Daniel Northcutt | Occupational Therapist | 1700 White St, Mount Vernon, IL 62864-4349 | 2014-11-11 |
| 1932132115 | Petersen Management Company, LLC | Skilled Nursing Facility | 1700 White St, Mount Vernon, IL 62864-4349 | 2006-07-09 |
| 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 | 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 |
|---|---|---|---|---|
| 1275056491 | Als Mount Vernon Inc | Skilled Nursing Facility | 1135 Gambier Rd, Mount Vernon, OH 43050-3839 | 2017-07-19 |
| 1679029110 | Tameka Bremmer | Skilled Nursing Facility | 171 W Kingsbridge Rd, 3rd Fl, Mount Vernon, NY 10550-4831 | 2016-08-25 |
| 1982813341 | Missouri Veterans Commission | Skilled Nursing Facility | 1600 S Hickory St, Mount Vernon, MO 65712-2045 | 2007-05-22 |
| 1689795379 | Ssc Mount Vernon Operating Company LLC | Skilled Nursing Facility | 1001 S 34th St, Mount Vernon, IL 62864-6232 | 2007-04-02 |
| 1437214970 | Mira Vista Corporation | Skilled Nursing Facility | 300 S 18th St, Mount Vernon, WA 98274-4661 | 2006-12-26 |
| 1598831869 | Mount Vernon Elderly Services LLC | Skilled Nursing Facility | 1350 Yauger Rd, Mount Vernon, OH 43050-9233 | 2006-11-28 |
| 1053483818 | Indiana Health and Rehabilitation Centers | Skilled Nursing Facility | 1415 Country Club Rd, Mount Vernon, IN 47620-9301 | 2006-11-15 |
| 1841374238 | Mt Vernon Nursing Home Inc | Skilled Nursing Facility | 501 Yates St, Mount Vernon, TX 75457-3233 | 2006-10-24 |
| 1558301812 | Tandem Health Care of Mt. Vernon, Inc. | Skilled Nursing Facility | 416 Wooster Rd, Mount Vernon, OH 43050-1216 | 2006-06-07 |
| 1861440174 | Westchester Center for Rehabilitation and Nursing | Skilled Nursing Facility | 10 Claremont Ave, Mount Vernon, NY 10550-1609 | 2006-05-05 |
| Find all providers in MOUNT VERNON | ||||
| 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.