Palladian Aviston SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1621197 Issued in IL

Legal business name

PALLADIAN AVISTON SNF LLC

Practice address

450 W 1St St
Aviston, IL 62216-3440

Phone

(618) 228-7615

Fax

(618) 228-7632

NPI assigned

Oct 11, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Jason Mills

Title

Cfo

Phone

(314) 566-0459

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AVISTON COUNTRYSIDE MANOR Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Skilled nursing facility certification: CCN 145601

Legal name

PALLADIAN AVISTON SNF, LLC

Doing business as

AVISTON COUNTRYSIDE MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Dec 12, 1988

Last certification

Jun 26, 2024

Beds

97

Ownership / control type

Corporation

Multi-facility organization

Palladian Healthcare

Organization structure

LLCProprietary

Incorporated

Sep 19, 2019 in IL

Enrollment address

450 W 1St St
Aviston, IL 62216-3440

Nursing home name

AVISTON COUNTRYSIDE MANOR

Affiliated entity

PALLADIAN HEALTHCARE

Listed as

Aviston Countryside ManorCCN 145601

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Dec 12, 1988

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9772.2 residents per day on average

Chain

Palladian Healthcare6 facilities in the chain

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1104814490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 ESSEX WAY STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693063",
            "telephone_number": "618-327-3064",
            "fax_number": "618-327-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 W 1ST ST",
            "city": "AVISTON",
            "state": "IL",
            "postal_code": "622163440",
            "telephone_number": "618-228-7615",
            "fax_number": "618-228-7632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALLADIAN AVISTON SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-566-0459",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "1621197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3712129346221601",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service?_ga=2.113516871.1947101893.1710724692-2000851276.1689896608",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "AVISTON COUNTRYSIDE MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Rose Fuehne, PT, DPT
• Spencer Daniel Fuehne, PT DPT
• Lauren Henrichs
• Oswald Pediatric Therapy LLC
• Ashley N Oswald, LPT
• Brett Peek
• Kim R Peek, LCSW
• Blair Elizabeth Pierson, FNP-C
• David Pierson
• Poettker Pediatric Therapy Services, P.C

• All providers in Aviston, IL
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.