NPIMap

Organization Active NPI

Clark-Lindsey Village Inc.

  • Rehabilitation Clinic/Center
  • Urbana, IL
National Provider Identifier
1033565882
Registry record updated Apr 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
CLARK-LINDSEY VILLAGE INC.
Practice address
101 W Windsor Rd
Urbana, IL 61802-6663
Phone
(217) 344-2144
Fax
(217) 344-9147
NPI assigned
May 11, 2016
Organization subpart
Yes
Parent organization
CLARK-LINDSEY VILLAGE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2017

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

Authorized official

Name
Debra Reardanz, ADMINISTRATOR
Title
Ceo/President
Phone
(217) 344-2144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

101 W Windsor Rd
Urbana, IL 61802-6663

Mailing address

101 W Windsor Rd
Urbana, IL 61802-6663
Phone (217) 344-2144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170516002042 IL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9638342660 Practice locations: Urbana, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clark-Lindsey Village Inc2 organizations share this tax ID, including this one
Part of
Clark-Lindsey Village Inc

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1462924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1033565882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W WINDSOR RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618026663",
            "telephone_number": "217-344-2144",
            "fax_number": "217-344-9147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W WINDSOR RD",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618026663",
            "telephone_number": "217-344-2144",
            "fax_number": "217-344-9147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK-LINDSEY VILLAGE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLARK-LINDSEY VILLAGE INC.",
        "enumeration_date": "2016-05-11",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "REARDANZ",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "217-344-2144",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.