Wood River NH LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WOOD RIVER NH LLC

Doing business as

Foxes Grove Supporting Living

Practice address

395 E Edwardsville Rd
Wood River, IL 62095-1600

Phone

(618) 259-0851

NPI assigned

Dec 10, 2016

Last updated

Jun 25, 2021By 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

James Mason

Title

President

Phone

(813) 347-7425

Specialties & licenses 1

Addresses

Other names 1

• Foxes Grove Supporting Living Doing business as

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

{
    "created_epoch": "1481328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1114461175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 E EDWARDSVILLE RD",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 E EDWARDSVILLE RD",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951600",
            "telephone_number": "618-259-0851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOOD RIVER NH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-10",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-347-7425"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foxes Grove Supporting Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Wood River, IL
• Providers in Wood River, 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 Jun 25, 2021; 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.