NPIMap

Organization Active NPI

Lebanon Terrace

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Lebanon, IL
National Provider Identifier
1104945716
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
0038430 Issued in IL
Legal business name
LEBANON TERRACE
Practice address
221 E 3Rd St
Lebanon, IL 62254-1668
Phone
(618) 537-4133
Fax
(618) 537-4156
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Donna L Jones
Title
QMRP
Phone
(618) 537-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 0038430 IL Primary

Addresses

Primary practice location

221 E 3Rd St
Lebanon, IL 62254-1668

Mailing address

221 E 3Rd St
Lebanon, IL 62254-1668
Phone (618) 537-4133

National Provider Directory

National Provider Directory
Tax ID family
Adloff Place6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104945716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 E 3RD ST",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541668",
            "telephone_number": "618-537-4133",
            "fax_number": "618-537-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 E 3RD ST",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541668",
            "telephone_number": "618-537-4133",
            "fax_number": "618-537-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON TERRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "QMRP",
        "authorized_official_telephone_number": "618-537-4133",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "0038430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.