Phillips Warner Realty, LLC - Monticello Operation Series

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PHILLIPS WARNER REALTY, LLC - MONTICELLO OPERATION SERIES

Practice address

901 Medical Center Dr
Monticello, IL 61856-2144

Phone

(217) 631-1136

NPI assigned

Oct 5, 2024

Organization subpart

Yes

Parent organization

PHILLIPS WARNER REALTY, LLCAs reported in NPPES

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

Authorized official

Name

Randy Porter, CFO

Title

Chief Financial Officer

Phone

(217) 345-5022

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1728086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1033938295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 18TH ST",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619204343",
            "telephone_number": "217-345-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MEDICAL CENTER DR",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618562144",
            "telephone_number": "217-631-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS WARNER REALTY, LLC - MONTICELLO OPERATION SERIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILLIPS WARNER REALTY, LLC",
        "enumeration_date": "2024-10-05",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "217-345-5022",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Monticello, IL
• Providers in Monticello, 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 Oct 7, 2024; 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.