Parents and Friends of the SLC-Home 1

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

6012769 Issued in IL

Legal business name

PARENTS AND FRIENDS OF THE SLC-HOME 1

Practice address

3 Gundlach PL
Swansea, IL 62226-4227

Phone

(618) 277-7730

Fax

(618) 277-5423

NPI assigned

Mar 3, 2008

Organization subpart

Yes

Parent organization

PARENTS AND FRIENDS OF THE SPECIALIZED LIVING CENTERAs reported in NPPES

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

Authorized official

Name

Mr. Charles K Keigley

Title

Administrator

Phone

(618) 277-7730

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Parents and Friends of the Specialized Living Center

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1184894412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 GUNDLACH PL",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622264227",
            "telephone_number": "618-277-7730",
            "fax_number": "618-277-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 GUNDLACH PL",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622264227",
            "telephone_number": "618-277-7730",
            "fax_number": "618-277-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARENTS AND FRIENDS OF THE SLC-HOME 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARENTS AND FRIENDS OF THE SPECIALIZED LIVING CENTER",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "KEIGLEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-277-7730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "6012769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6012769",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in Swansea, IL
• Providers in Swansea, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.