Menard Convalescent Center, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0003020 Issued in IL

Legal business name

MENARD CONVALESCENT CENTER, INC

Practice address

120 W Antle St
Petersburg, IL 62675-1035

Phone

(217) 632-2249

Fax

(217) 632-7810

NPI assigned

Oct 14, 2008

Last updated

Oct 14, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerry W Jennings

Title

Controller

Phone

(217) 787-8530

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1003068776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2653 W LAWRENCE AVE STE B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627041115",
            "telephone_number": "217-787-8530",
            "fax_number": "217-785-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W ANTLE ST",
            "city": "PETERSBURG",
            "state": "IL",
            "postal_code": "626751035",
            "telephone_number": "217-632-2249",
            "fax_number": "217-632-7810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENARD CONVALESCENT CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "217-787-8530"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0003020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary N Hollis, RN
• Hillary Maria Kelly, IBCLC
• Katherine A Krall, CFNP
• Amanda L. Meeks, M.D.
• Memorial Physician Services
• Menard Convalescent Center, Inc
• Menard County Health Department
• Menard Medical Center, LLC
• Menard Medical Center, LLC
• Tracy Ann Muller, MS SLP CCC

• Skilled Nursing Facility in Petersburg, IL
• Providers in Petersburg, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.