NPIMap

Organization Active NPI

Beverly Farm Foundation

  • Intellectual Disabilities Intermediate Care Facility
  • Godfrey, IL
National Provider Identifier
1174696157
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0038604 Issued in IL
Legal business name
BEVERLY FARM FOUNDATION
Practice address
6301 Humbert Rd
Godfrey, IL 62035-2163
Phone
(618) 466-0367
Fax
(618) 466-3652
NPI assigned
Nov 16, 2006
Last updated
Aug 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

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

Authorized official

Name
Mrs. Brenda E. Miller
Title
Finance Director
Phone
(618) 466-0367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0038604 IL Primary

Addresses

Primary practice location

6301 Humbert Rd
Godfrey, IL 62035-2163

Mailing address

6301 Humbert Rd
Godfrey, IL 62035-2163
Phone (618) 466-0367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051130000206 IL Part B Supplier - Mass Immunization (Roster Biller Only) 5991725350 Practice locations: Godfrey, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174696157. Details of each certification follow.

  • CCN 14G060 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G060

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BEVERLY FARM FOUNDATION
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 17, 1980
Last certification
Dec 19, 2024
Beds
300
Ownership / control type
Private (non-profit)
Facility address
6301 Humbert Road
Godfrey, IL 62035

National Provider Directory

National Provider Directory
Tax ID family
Beverly Farm Foundation7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1174696157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 HUMBERT RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352163",
            "telephone_number": "618-466-0367",
            "fax_number": "618-466-3652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 HUMBERT RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352163",
            "telephone_number": "618-466-0367",
            "fax_number": "618-466-3652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY FARM FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "618-466-0367",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0038604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Godfrey, IL

Sources for this page

Verify at the official NPI Registry.