Eagle Ridge of Decatur, LP

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EAGLE RIDGE OF DECATUR, LP

Practice address

875 W McKinley Ave
Decatur, IL 62526-3287

Phone

(217) 872-1282

Fax

(217) 872-1227

NPI assigned

Apr 4, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra K Barton

Title

Administrator

Phone

(217) 872-1282

Specialties & licenses 1

Addresses

Other names 1

• BMA Management Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316069099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 W MCKINLEY AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263287",
            "telephone_number": "217-872-1282",
            "fax_number": "217-872-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 W MCKINLEY AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263287",
            "telephone_number": "217-872-1282",
            "fax_number": "217-872-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIDGE OF DECATUR, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARTON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "217-872-1282",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMA Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jonathan Roderick Dutt, MD
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• Sara Ann Ecklund, PHARM.D.
• Merrik Eddington, D.M.D.

• Assisted Living Facility in Decatur, IL
• Providers in Decatur, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.