Benjamin Green Field Residence

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

000041582 Issued in IL

Legal business name

BENJAMIN GREEN FIELD RESIDENCE

Practice address

14245 W Rockland Rd
Libertyville, IL 60048-9713

Phone

(847) 362-4636

Fax

(847) 362-0742

NPI assigned

Apr 22, 2008

Last updated

Apr 22, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

THE LAMBS FARM, INC.As reported in NPPES

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

Authorized official

Name

Patriica McGuire, CPA

Title

Controller

Phone

(847) 990-3710

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275707127. Details of each certification follow.

• CCN 14G364 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G364

Legal name

BENJAMIN GREEN-FIELD RESIDENCE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Oct 1, 1997

Last certification

Oct 7, 2024

Beds

16

Ownership / control type

Private (non-profit)

Facility address

14245 West Rockland Road
Libertyville, IL 60048

Tax ID family

Benjamin Green Field Residence3 organizations share this tax ID, including this one

Part of

Benjamin Green Field Residence

Other organizations with this tax ID 2

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

• The Lambs Farm, Inc

  • Adult Mental Health Clinic/Center
  • Libertyville, IL
  • NPI 1154134682
  NPD tax ID
• The Lambs Farm, Inc.

  dba Lambs Farm

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Libertyville, IL
  • NPI 1861859290
  NPD tax ID

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1275707127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 520",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600480520",
            "telephone_number": "847-362-4636",
            "fax_number": "847-362-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14245 W ROCKLAND RD",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600489713",
            "telephone_number": "847-362-4636",
            "fax_number": "847-362-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN GREEN FIELD RESIDENCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LAMBS FARM, INC.",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "MCGUIRE",
        "authorized_official_first_name": "PATRIICA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "847-990-3710",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "000041582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Beckman, PT, DPT
• Klaudia Bednarczyk, MS, CCC-SLP
• Kelly J Behrends, PSYD
• Evelyn Bello
• Krysty Lynne Benhart-Martel, D.C.
• Bennett Chiropractic Care SC
• Thomas W Bennett, DC
• Anna Benton, PHD
• Elizabeth Ann Benvenuto, MS
• Mussie Beraki, M.D.

• Intellectual Disabilities Intermediate Care Facility in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.