NPIMap

Organization Active NPI

Caravilla Residential Centers, Inc

Doing business as Mt Vernon Care Center

  • Nursing Facility/Intermediate Care Facility
  • Mount Vernon, IL
National Provider Identifier
1184616195
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
0039826 Issued in IL
Legal business name
CARAVILLA RESIDENTIAL CENTERS, INC
Doing business as
Mt Vernon Care Center
Practice address
1717 Jefferson Ave
Mount Vernon, IL 62864-4330
Phone
(618) 244-2861
Fax
(618) 244-2393
NPI assigned
Aug 16, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael F Flanagan
Title
Corporate Attorney
Phone
(816) 444-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 0039826 IL Primary

Addresses

Primary practice location

1717 Jefferson Ave
Mount Vernon, IL 62864-4330

Mailing address

1717 Jefferson Ave
Mount Vernon, IL 62864-4330
Phone (618) 244-2861

Other names 1

  • MT VERNON CARE CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Caravilla Residential Centers Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184616195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 JEFFERSON AVE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644330",
            "telephone_number": "618-244-2861",
            "fax_number": "618-244-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 JEFFERSON AVE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644330",
            "telephone_number": "618-244-2861",
            "fax_number": "618-244-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARAVILLA RESIDENTIAL CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLANAGAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CORPORATE ATTORNEY",
        "authorized_official_telephone_number": "816-444-0900"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0039826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MT VERNON CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.