Southern Illinois Living Centers Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0033159 Issued in IL

Legal business name

SOUTHERN ILLINOIS LIVING CENTERS INC.

Doing business as

Clinton Manor Living Center

Practice address

111 E Illinois St
New Baden, IL 62265-1850

Phone

(618) 588-4924

Fax

(618) 588-4673

NPI assigned

Sep 14, 2005

Last updated

Nov 9, 2011By 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

Mr. Michael A Brave, MSW

Title

Vice President Administrator

Phone

(618) 588-2066

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Clinton Manor Living Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1174518278. Details of each certification follow.

• CCN 146025 Skilled nursing facility · Active · Details
• CCN 14G111 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Skilled nursing facility certification: CCN 146025

Legal name

SOUTHERN ILLINOIS LIVING CENTERS INC.

Doing business as

CLINTON MANOR LIVING CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

May 1, 2002

Last certification

Sep 5, 2024

Beds

39 (37 certified)

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Enrollment address

111 E Illinois St
New Baden, IL 62265-1850

Nursing home name

CLINTON MANOR LIVING CENTER

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G111

Legal name

CLINTON MANOR LIVING CENTER-DD

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

May 28, 1986

Last certification

Feb 6, 2025

Beds

51

Ownership / control type

Private (proprietary)

Facility address

111 East Illinois Street
New Baden, IL 62265

Listed as

Clinton Manor Living CenterCCN 146025 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

May 1, 2002

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3721.9 residents per day on average

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

All disclosed owners & managing parties 66

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Erin Elizabeth Fancher Gagen, MD

  • Family Medicine Physician
  • Trenton, IL
  • NPI 1184657090

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Erin Elizabeth Fancher Gagen, MD

  • Family Medicine Physician
  • Trenton, IL
  • NPI 1184657090

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320796800000",
    "number": "1174518278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E ILLINOIS ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651850",
            "telephone_number": "618-588-2066",
            "fax_number": "618-588-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E ILLINOIS ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651850",
            "telephone_number": "618-588-4924",
            "fax_number": "618-588-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS LIVING CENTERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-14",
        "last_updated": "2011-11-09",
        "status": "A",
        "authorized_official_last_name": "BRAVE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT ADMINISTRATOR",
        "authorized_official_telephone_number": "618-588-2066",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0033159",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0033159",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH LICENSE NUMBER",
            "identifier": "0033159",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinton Manor Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Royal Living Center
• Royal Living Center Inc
• Lynn Kelly Ryder, LCPC
• Jennifer Sipula, PT
• Southern Illinois Community Support Services
• Southern Illinois Living Centers Inc. (Clitnon Manor Living Center)
• Jessa Kate Springer
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde (Clinton County Rural Health New Baden)
• Robert Stephens
• Tracy Hermanson (Tracy Hermanson Therapy)

• Skilled Nursing Facility in New Baden, IL
• Providers in New Baden, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.