Beverly Enterprises - Illinois, Inc.
Organization Active NPI Skilled Nursing Facility · Wood River, IL
NPI 1275628448 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1275628448
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BEVERLY ENTERPRISES - ILLINOIS, INC.
- Practice address
- 393 E Edwardsville Rd
Wood River, IL 62095-1646 - Phone
- (618) 259-4111
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
Authorized official
- Name
- David Merrell
- Title
- Vice President
- Phone
- (479) 201-4840
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Beverly Enterprises - Illinois Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
393 E Edwardsville Rd
Wood River, IL 62095-1646
Mailing address
393 E Edwardsville Rd
Wood River, IL 62095-1646
Phone (618) 259-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105320 | Other | IL | BCBS |
| 47523 | Other | IL | GROUP HP |
Other names
- VIP Manor
Other providers in Wood River, IL
- Karen Augustyn
- Leslie A Baker
- Katie Lynn Bartels
- Rachael Ann Beard
- Behavioral Health Alternatives, Inc
- Jared Andrew Blaylock
- Bravo Care of Wood River Inc
- Bria of Woodriver LP
- Bob Burris
- Laura Burton
All providers in Wood River, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.