NPIMap

Organization Active NPI

Marianjoy at Providence Victorian Village

  • Skilled Nursing Facility
  • Homer Glen, IL
National Provider Identifier
1174912562
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MARIANJOY AT PROVIDENCE VICTORIAN VILLAGE
Practice address
12525 Renaissance Cir
Homer Glen, IL 60491-5896
Phone
(708) 590-5050
NPI assigned
Jan 22, 2015
Last updated
Jan 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

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

Authorized official

Name
Ms. Laura J. BookerNPI 1104215573
Title
PFS Contracted Lead
Phone
(630) 909-7374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

12525 Renaissance Cir
Homer Glen, IL 60491-5896

Mailing address

12525 Renaissance Cir
Homer Glen, IL 60491-5896
Phone (708) 590-5050

National Provider Directory

National Provider Directory
Tax ID family
Noel Rao MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1174912562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12525 RENAISSANCE CIR",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604915896",
            "telephone_number": "708-590-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12525 RENAISSANCE CIR",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604915896",
            "telephone_number": "708-590-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIANJOY AT PROVIDENCE VICTORIAN VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PFS CONTRACTED LEAD",
        "authorized_official_telephone_number": "630-909-7374",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer Glen, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.