Marys Village Foundation

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MARYS VILLAGE FOUNDATION

Practice address

3922 N Belt W
Belleville, IL 62226-5608

Phone

(618) 974-4807

NPI assigned

Apr 27, 2022

Last updated

Apr 27, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Shanta Doss, MSNPI 1932687571

Title

Owner

Phone

(618) 974-4807

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shanta Doss

  • Driver
  • Swansea, IL
  • NPI 1932687571
  NPD Authorized official

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1104560838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 N BELT W",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265608",
            "telephone_number": "618-974-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 N BELT W",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265608",
            "telephone_number": "618-974-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYS VILLAGE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A",
        "authorized_official_last_name": "DOSS",
        "authorized_official_first_name": "SHANTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-974-4807",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Renee Martens, LCPC
• Evelyn Teresa Martin, RN
• Jamaal Martin
• Jonah Daniel Martin, BCBA
• Megan Martin
• Kayla Elizabeth Maschhoff, M.S., CCC-SLP
• Lacee Dian Maslanka
• Jaycie Rhea Mathews, RN
• Steven C Mathus, M.D.
• Stacy Mattern, PT

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Belleville, IL
• Providers in Belleville, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.