Greenwood Manor Nursing Home Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0020206 Issued in IL

Legal business name

GREENWOOD MANOR NURSING HOME INC

Practice address

410 Fletcher St
Jerseyville, IL 62052-2127

Phone

(618) 498-6427

Fax

(618) 639-3339

NPI assigned

Oct 20, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Lawrence B Plummer, DO

Title

Owner

Phone

(618) 498-6427

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336138411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 FLETCHER ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522127",
            "telephone_number": "618-498-6427",
            "fax_number": "618-639-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 FLETCHER ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522127",
            "telephone_number": "618-498-6427",
            "fax_number": "618-639-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD MANOR NURSING HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PLUMMER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-498-6427",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0020206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL DEPT OF PUBLIC HEALTH",
            "identifier": "I4A111",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David J Goetten, D.M.D.
• Edward Eugene Goetten, D.O
• Marianne C. Golike, LCPC
• Great Rivers Eye Care
• Katelyn Elizabeth Green
• Lindsay Grififn, BEHAVIOR TECHNICIAN
• John Michael Guercio, PHD BCBA-D CBIST
• Carla R Hagen
• Janine Zahrli Hagen
• Molly Hagen

• Nursing Facility/Intermediate Care Facility in Jerseyville, IL
• Providers in Jerseyville, 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 Aug 22, 2020; 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.