Penta Group Inc.

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

002 Issued in IL

Legal business name

PENTA GROUP INC.

Doing business as

Bryan Manor

Practice address

300 Schoonover Drive
Salem, IL 62881

Phone

(618) 548-4561

NPI assigned

Feb 13, 2008

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Georgia Miller

Title

Administrator

Phone

(618) 548-4561

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BRYAN MANOR Doing business as

Tax ID family

Bryan Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Penta Group Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1932246071
  NPD tax ID

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Debra L Bredar

  • Developmental Therapist
  • Centralia, IL
  • NPI 1912281833
  NPD (past)
• Bethany Hanks

  • Developmental Therapist
  • Centralia, IL
  • NPI 1538474218
  NPD (past)
• Teresa Hutchison

  • Developmental Therapist
  • Centralia, IL
  • NPI 1982959037
  NPD (past)
• Bailey Morgan Lindsey

  • Developmental Therapist
  • Centralia, IL
  • NPI 1356082200
  NPD (past)
• Jana L Mullinax, COTA/ L

  • Occupational Therapy Assistant
  • Centralia, IL
  • NPI 1487947602
  NPD (past)
• Jessie M Schaudt

  • Developmental Therapist
  • Centralia, IL
  • NPI 1174876064
  NPD (past)
• Emily Smith

  • Developmental Therapist
  • Centralia, IL
  • NPI 1265111272
  NPD (past)

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366610321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1946",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628019127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SCHOONOVER DRIVE",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "62881",
            "telephone_number": "618-548-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTA GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-548-4561"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "IL",
            "license": "002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G0370033373",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRYAN MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novacare Rehabilitation
• Kimber Dawn Organ
• Karlie Kaitlyn Orozco
• Thomas Henry Partain, L.O.T.
• Keri A Paulson, OTR/L
• Penta Nascent Corporation (Lynwood Estates)
• Physician Services Corp of Southern Illinois (St Marys Good samaritan Medical Group)
• Erik B Pikas, M.D.
• Mary K Piper, FNP
• Haley Nicole Rambo, OD

• Non-emergency Medical Transport (VAN) in Salem, IL
• Providers in Salem, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.