NPIMap

Organization Active NPI

Southern Illinois Center for Independent Living

  • Case Management Agency
  • Carbondale, IL
National Provider Identifier
1043867112
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SOUTHERN ILLINOIS CENTER FOR INDEPENDENT LIVING
Practice address
2135 W. Ramada Lane
Carbondale, IL 62901-5326
Phone
(618) 457-3318
Fax
(618) 549-0132
NPI assigned
Aug 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Authorized official

Name
Bonnie VaughnNPI 1326347121
Title
Executive Director
Phone
(618) 457-3318

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary
Voluntary or Charitable Agency 251V00000X
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

2135 W. Ramada Lane
Carbondale, IL 62901-5326

Mailing address

2135 W. Ramada Lane
Carbondale, IL 62901-5326
Phone (618) 457-3318

National Provider Directory

National Provider Directory
Tax ID family
Southern Illinois Center for Independent Living2 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.

Locations

2135 W Ramada Ln
Carbondale, IL 62901
Phone (618) 303-6547

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1043867112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2135 W. RAMADA LANE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015326",
            "telephone_number": "618-457-3318",
            "fax_number": "618-549-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 W. RAMADA LANE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015326",
            "telephone_number": "618-457-3318",
            "fax_number": "618-549-0132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS CENTER FOR INDEPENDENT LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-457-3318"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; 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.