Cye Sullivan Hco, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CYE SULLIVAN HCO, LLC

Practice address

20 Courtyard Blvd
Sullivan, IL 61951-7001

Phone

(217) 728-4300

NPI assigned

Feb 17, 2020

Organization subpart

No

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

Authorized official

Name

Mark B. Petersen

Title

Manager

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1164055323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W TRAILCREEK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141862",
            "telephone_number": "309-689-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 COURTYARD BLVD",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619517001",
            "telephone_number": "217-728-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CYE SULLIVAN HCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-691-8113"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David L Cole, LCSW, LPHA
• Community Homecare Inc
• Tatum Copsy, BS
• County of Moultrie
• Cassandra Cox
• Bradford Dawson
• Christyna De Lude
• Dearnbarger Family Practice S.C.
• Decatur Memorial Hospital
• Lisa Dickens, MS. CADC

• All providers in Sullivan, IL
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; 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.