Adeline E. Prouty Trust

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

0021956 Issued in IL

Legal business name

ADELINE E. PROUTY TRUST

Doing business as

Greenfield Home

Practice address

508 Park Ave E
Princeton, IL 61356-2538

Phone

(815) 872-2261

Fax

(815) 875-1758

NPI assigned

May 16, 2007

Last updated

Aug 22, 2020By 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

Mr. Phillip Karl Kaufmann

Title

Administrator

Phone

(815) 872-2261

Specialties & licenses 1

Addresses

Other names 1

• Greenfield Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013124593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613562538",
            "telephone_number": "815-872-2261",
            "fax_number": "815-875-1758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 PARK AVE E",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613562538",
            "telephone_number": "815-872-2261",
            "fax_number": "815-875-1758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADELINE E. PROUTY TRUST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KAUFMANN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-872-2261",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "0021956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenfield Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Princeton, IL
• Providers in Princeton, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.