KENDRA MICKELSON (NPI# 1992158356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992158356 |
| Entity Type | Individual |
| Full Name | KENDRA MICKELSON |
| Practice Address |
700 N Main St Eureka IL 61530-1085 |
| Practice Telephone | 3094679094 |
| Practice Fax Number | 3094679011 |
| Mailing Telephone | 3094679094 |
| Mailing Fax Number | 3094679011 |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 314000000X | Skilled Nursing Facility | 1694647 | IL | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | 0042424 | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | TAXONOMY NUMBER | 314000000X | 01 |
| IL | 0042424 | 05 |
| Street Address |
700 N MAIN ST |
| City | EUREKA |
| State | IL |
| Zip Code | 61530-1085 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720073414 | Maple Lawn Health Center | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2005-09-19 |
| 1720439110 | Loft Rehabilitation and Nursing LLC | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-06-27 |
| 1841470374 | Maple Lawn Homes Inc. | Clinic/Center | 700 N Main St, Eureka, IL 61530-1085 | 2007-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134464316 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 101 S. Major Street, Eureka, IL 61530 | 2012-11-29 |
| 1508009234 | Woodford County | Substance Abuse Rehabilitation Facility | 105 E Court St, Eureka, IL 61530 | 2009-04-10 |
| 1609889914 | Apostolic Christian Home of Eureka | Skilled Nursing Facility | 610 W. Cruger St., Eureka, IL 61530 | 2006-08-15 |
| 1326003344 | Eric John Larson | Counselor | 109 E Eureka, Eureka, IL 61530 | 2006-04-20 |
| 1467789511 | Julie Tuttle | Clinical Nurse Specialist | 530 Ne Glen Oak Ave, Peoria, IL 61530 | 2009-11-11 |
| 1093818767 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 501 W Center St, Eureka, IL 61530-1111 | 2006-09-07 |
| 1871911859 | Alan Stutzman | Pharmacist | 501 W Center St, Eureka, IL 61530-1111 | 2014-04-07 |
| 1568583375 | Sarah Ann Harmon | Pharmacist | 501 W Center St, Eureka, IL 61530-1111 | 2007-04-02 |
| 1013157148 | Chevi B. Guthrie | Chiropractor | 105 W Mill St, Eureka, IL 61530-1138 | 2009-03-03 |
| 1750628285 | Elite Chiropractic Services, LLC | Chiropractor | 105 W Mill St, Eureka, IL 61530-1138 | 2013-01-03 |
| Find all providers in zip 61530 | ||||
| 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 |
|---|---|---|---|---|
| 1316035074 | Medicalodges, Inc. | Skilled Nursing Facility | 1020 N School St, Route 2, Box 94-c, Eureka, KS 67045-1106 | 2006-10-10 |
| 1609889914 | Apostolic Christian Home of Eureka | Skilled Nursing Facility | 610 W. Cruger St., Eureka, IL 61530 | 2006-08-15 |
| 1720012347 | St. Andrew's At Francis Place | Skilled Nursing Facility | 300 Forby Road, Eureka, MO 63025-0476 | 2006-07-10 |
| 1306824248 | Granada Healthcare & Rehabilitation Center, LLC | Skilled Nursing Facility | 2885 Harris St, Eureka, CA 95503-4808 | 2005-12-30 |
| 1386621357 | Eureka Healthcare and Rehabilitation Center, LLC | Skilled Nursing Facility | 2353 23rd St, Eureka, CA 95501-3201 | 2005-12-29 |
| 1144206020 | Avera St. Lukes | Skilled Nursing Facility | 202 J Ave., Eureka, SD 57437-2225 | 2005-12-21 |
| 1811984495 | Seaview Healthcare and Rehabilition,llc | Skilled Nursing Facility | 6400 Purdue Dr, Eureka, CA 95503-7095 | 2005-09-29 |
| 1720073414 | Maple Lawn Health Center | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2005-09-19 |
| 1720439110 | Loft Rehabilitation and Nursing LLC | Skilled Nursing Facility | 700 N Main St, Eureka, IL 61530-1085 | 2016-06-27 |
| 1003113705 | Granada Rehabilitation & Wellness Center, Lp | Skilled Nursing Facility | 2885 Harris St, Eureka, CA 95503-4808 | 2011-02-16 |
| Find all providers in EUREKA | ||||
Please comment or provide details below to improve the information on KENDRA MICKELSON.
| 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.