Phillips Investment, LLC - Jerseyville Operation Series

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PHILLIPS INVESTMENT, LLC - JERSEYVILLE OPERATION SERIES

Practice address

1318 State Highway 109
Jerseyville, IL 62052-6886

Phone

(618) 494-4500

NPI assigned

Oct 5, 2024

Last updated

Oct 7, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

PHILLIPS INVESTMENTS, 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

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": "1073332235",
    "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": "1318 STATE HIGHWAY 109",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620526886",
            "telephone_number": "618-494-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS INVESTMENT, LLC - JERSEYVILLE OPERATION SERIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILLIPS INVESTMENTS, 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 Jerseyville, IL
• Providers in Jerseyville, 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.