Gahcr II Mahomet Alf TRS Sub, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GAHCR II MAHOMET ALF TRS SUB, LLC

Doing business as

The Glenwood of Mahomet

Practice address

1709 S Division St
Mahomet, IL 61853-3747

Phone

(217) 586-5100

Fax

(217) 586-5151

NPI assigned

Mar 26, 2015

Organization subpart

No

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

Authorized official

Name

Danny Prosky

Title

President

Phone

(949) 270-9200

Specialties & licenses 1

Addresses

Other names 1

• The Glenwood of Mahomet Doing business as

Locations

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1245624311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1709 S DIVISION ST",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618533747",
            "telephone_number": "217-586-5100",
            "fax_number": "217-586-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 S DIVISION ST",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618533747",
            "telephone_number": "217-586-5100",
            "fax_number": "217-586-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAHCR II MAHOMET ALF TRS SUB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-26",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "PROSKY",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-270-9200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Glenwood of Mahomet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyson Dyck
• Kathryn Eichen
• Rachel Einck
• Morgan L. Flex Siebert
• Ahmed Gadelkarim
• Gibson Community Hospital Association (Gibson Health of Mahomet)
• Gibson Community Hospital Association (Mahomet Specialty Clinic)
• Sirisha Gogineni, DDS
• Brittany S Good, LPN
• Ann Marie Graham, OTR/L

• Assisted Living Facility in Mahomet, IL
• Providers in Mahomet, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.