222 State Street Properties, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

222 STATE STREET PROPERTIES, LLC

Doing business as

Eden Champaign

Practice address

222 N State St
Champaign, IL 61820-3937

Phone

(217) 903-5900

Fax

(217) 378-6829

NPI assigned

Oct 16, 2013

Last updated

Oct 16, 2013By 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

Kimberly Cross

Title

Executive Director

Phone

(217) 903-5900

Specialties & licenses 1

Addresses

Other names 1

• Eden Champaign Doing business as

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1134557846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N STATE ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203937",
            "telephone_number": "217-903-5900",
            "fax_number": "217-378-6829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N STATE ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203937",
            "telephone_number": "217-903-5900",
            "fax_number": "217-378-6829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "222 STATE STREET PROPERTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "CROSS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "217-903-5900"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Champaign",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ghada Abdalla

• Assisted Living Facility in Champaign, IL
• Providers in Champaign, 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 16, 2013; 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.