Unlimited Development, Inc
Organization Active NPI Skilled Nursing Facility · Maryville, IL
NPI 1013904366 · NPPES record last updated Jan 13, 2011
Key facts
- NPI
- 1013904366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 48462 (IL)
- Legal business name
- UNLIMITED DEVELOPMENT, INC
- Practice address
- 6955 State Route 162
Maryville, IL 62062-8531 - Phone
- (618) 288-5999
- Fax
- (618) 288-1106
- NPI assigned
- Oct 3, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Ronald J Wilson
- Title
- Cfo
- Phone
- (309) 343-1550
Owners & managing parties with NPI records 10
-
Robert Wagner, M.D.
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 9
Facilities with the same owner 5
Affiliated clinicians 1
-
John A Flick, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Manor Court of Maryville
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Mar 19, 1992
- Medicare certification status
- Active
- Certified beds
- 132 · 112.4 residents per day on average
- Chain
- Unlimited Development, Inc.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0861769 | Manor Court of Maryville | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Skilled nursing facility certification: CCN 145728
- Legal name
- UNLIMITED DEVELOPMENT, INC
- Doing business as
- MANOR COURT OF MARYVILLE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 19, 1992
- Last certification
- Nov 1, 2024
- Beds
- 132
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Unlimited Development INC
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 17, 1996 in IL
- Enrollment address
- 6955 State Route 162
Maryville, IL 62062-8531 - Nursing home name
- MANOR COURT OF MARYVILLE
- Affiliated entity
- UNLIMITED DEVELOPMENT, INC.
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Audrey J Finke |
Corporate Officer |
Aug 30, 2018 | |
| Corporate Director |
Oct 1, 2006 | ||
| Jerry D Gilmore |
Corporate Director | Oct 1, 2006 | |
| Ronald J Wilson |
Corporate Officer |
Aug 30, 2018 | |
| Johnny Gordon Law |
W-2 Managing Employee |
Aug 30, 2018 | |
| David S Haney |
Corporate Director | Oct 1, 2006 | |
| Unlimited Development, Inc |
5% Or Greater Indirect Ownership Interest | Jan 7, 2014 | 100% |
| Operational/Managerial Control | Jan 16, 2014 | ||
| Robert H Wagner |
Corporate Director | Oct 1, 2006 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Seminary Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2009 |
| Parkway Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2009 |
| Pekin Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest | Jun 1, 2009 |
| Centralia Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest | Jun 1, 2009 |
| River Hills Village |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090720000069 | IL | Part a Provider - Skilled Nursing Facility | 6901995513 | Practice locations: Maryville, IL |
National Provider Directory
- Tax ID family
- Unlimited Development Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 48462 | IL | Yes |
Addresses
Primary practice location
6955 State Route 162
Maryville, IL 62062-8531
Mailing address
6955 State Route 162
Maryville, IL 62062-8531
Phone (618) 288-5999
Other names
- UDI NO2 Manor Court of Maryville
Other providers in Maryville, IL
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- Robin Turner-Viviano
- Solange Tuyishime
- George E Tzelepis
- Uptown Emergency Physicians LLP
- Uptown Emergency Physicians, LLP
- Mary Vaughn
- Patricia Renee Verdu
- Christina Vermaux
All providers in Maryville, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.