Hickory Estates

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0030510 Issued in IL

Legal business name

HICKORY ESTATES

Practice address

310 Otha Street
Sumner, IL 62466-0164

Phone

(618) 936-2004

Fax

(618) 936-2556

NPI assigned

Apr 23, 2008

Last updated

Apr 23, 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

Ms. Peter Michael Narish, ADMINISTRATOR

Title

Administrator

Phone

(618) 936-2004

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Hickory Estates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Hickory Estates

  • Lodging Provider
  • Sumner, IL
  • NPI 1790981769
  NPD tax ID

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1013182807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 OTHA STREET",
            "city": "SUMNER",
            "state": "IL",
            "postal_code": "62466",
            "telephone_number": "618-936-2004",
            "fax_number": "618-936-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 OTHA STREET",
            "city": "SUMNER",
            "state": "IL",
            "postal_code": "624660164",
            "telephone_number": "618-936-2004",
            "fax_number": "618-936-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY ESTATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "NARISH",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-936-2004",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0030510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G105",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathy Cotterell, MS CCC SLP L
• Regina Hall-Ngorima, MD
• Hickory Estates
• Lynda Hoke, MSN, APRN, PMHNP-BC
• Kevin D Sager, D.C.
• Sara Stover, NP
• Sumner Health Clinic, LTD.

• Intellectual Disabilities Intermediate Care Facility in Sumner, IL
• Providers in Sumner, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.