Shabbona Supportive Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SHABBONA SUPPORTIVE LIVING

Practice address

407 W Comanche Ave
Shabbona, IL 60550-9501

Phone

(815) 824-8480

Fax

(815) 824-2412

NPI assigned

Sep 28, 2007

Organization subpart

No

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

Authorized official

Name

Delores J Nicolson

Title

Manager

Phone

(815) 824-8480

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• none Doing business as

Tax ID family

Shabbona Health Care Center2 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.

• Shabbona Helath Care Center

  • Oxygen Equipment & Supplies (DME)
  • Shabbona, IL
  • NPI 1972778611
  NPD tax ID

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1366639833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 W COMANCHE AVE",
            "city": "SHABBONA",
            "state": "IL",
            "postal_code": "605509501",
            "telephone_number": "815-824-8480",
            "fax_number": "815-824-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 W COMANCHE AVE",
            "city": "SHABBONA",
            "state": "IL",
            "postal_code": "605509501",
            "telephone_number": "815-824-8480",
            "fax_number": "815-824-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHABBONA SUPPORTIVE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "NICOLSON",
        "authorized_official_first_name": "DELORES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "815-824-8480"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204590974001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "none",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prairie Crossing Assisted Living, LLC
• Prairie Crossing Living & Rehabilitation Center, LLC
• Shabbona Comm Fire District
• Shabbona Health Care Center
• Shabbona Helath Care Center
• Shabbona Supportive Living
• Leslie Ward, M.A., SLP

• Assisted Living Facility in Shabbona, IL
• Providers in Shabbona, 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 Apr 17, 2008; 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.