NPIMap

Organization Active NPI

Henry & Jane Vonderlieth Living Center Inc

Doing business as The H & J Vonderlieth LVG CTR

  • Skilled Nursing Facility
  • Mount Pulaski, IL
National Provider Identifier
1376538157
Registry record updated May 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
19976 Issued in IL
Legal business name
HENRY & JANE VONDERLIETH LIVING CENTER INC
Doing business as
The H & J Vonderlieth LVG CTR
The Henry & Jane Vonderlieth Living Center
Practice address
1120 N Topper Dr
Mt Pulaski, IL 62548-1401
Phone
(217) 792-3218
Fax
(217) 792-3210
NPI assigned
Sep 16, 2005
Last updated
May 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2017

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

Authorized official

Name
Mr. David M Underwood
Title
Sr. VP & Cfo
Phone
(309) 823-7135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 19976 IL Primary

Addresses

Primary practice location

1120 N Topper Dr
Mt Pulaski, IL 62548-1401

Mailing address

115 W Jefferson St
Ste 401
Bloomington, IL 61701-3967
Phone (309) 828-4361

Other names 2

  • The H & J Vonderlieth LVG CTR Doing business as
  • The Henry & Jane Vonderlieth Living Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030124000014 IL Part A Provider - Skilled Nursing Facility 7517875214 Practice locations: Mount Pulaski, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376538157. Details of each certification follow.

Skilled nursing facility certification: CCN 146042

Legal name
HENRY & JANE VONDERLIETH LIVING CENTER INC
Doing business as
THE H & J VONDERLIETH LVG CTR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 14, 2003
Last certification
Sep 12, 2024
Beds
90
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
1120 N Topper Dr
Mount Pulaski, IL 62548-1401
Nursing home name
H & J VONDERLIETH LVG CTR, THE
Affiliated entity
HERITAGE OPERATIONS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
H & J Vonderlieth LVG Ctr, theCCN 146042 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Feb 14, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9056.2 residents per day on average
Chain
Heritage Operations Group9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Henry Jane Vonderlieth Living Center Inc2 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.

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Catherine McDowell Individual Corporate DirectorRegional Director of Operations Apr 1, 2022
Richard Volle Individual Corporate Director Jan 1, 2016
Thomas Cross Individual Corporate Director Nov 2, 2007
Donna Kincade Individual Corporate DirectorAdministrator Jun 25, 2018
Adp of the SNF Feb 4, 2025
Kaitlin Weitekamp Individual Corporate Director Jan 1, 2025
Julian Wubben Individual Corporate Director Sep 15, 2011 10%
Heritage Operations Group, LLC Organization, Bloomington, IL For-profit, Chain home office Operational/Managerial Control May 9, 2017 100%
Trustee of the SNF May 9, 2017
Adp of the SNF Jan 2, 2025
Pat Przykopanski Individual Corporate Director May 9, 2017 20%
Jeff Martin Individual Corporate Director Sep 15, 2011 10%
Richard Aylesworth Individual Corporate Director May 9, 2017 20%
Derek Martin Individual Corporate Director Jan 1, 2025
Henry & Jane Vonderlieth Living Center Inc Organization, Mount Pulaski, IL Non-profit 5% Or Greater Direct Ownership Interest May 9, 2017 100%
Lynn Freer Individual Corporate Officer Oct 1, 2012 10%
James Hild Individual Corporate Officer Oct 1, 2012 10%
Benjamin a Hart Individual Operational/Managerial ControlSr VP Corporate Services Jul 21, 2011 20%
Daniel Curry Individual Corporate OfficerExec VP & Cfo Jun 7, 2022
Melissa Lynn Cox Individual Corporate DirectorMedical Director Jan 1, 2022
Adp of the SNF Feb 4, 2025
Steven Hart Individual Corporate Officer Jul 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496102400000",
    "number": "1376538157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W JEFFERSON ST",
            "address_2": "STE 401",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013967",
            "telephone_number": "309-828-4361",
            "fax_number": "309-829-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N TOPPER DR",
            "city": "MT PULASKI",
            "state": "IL",
            "postal_code": "625481401",
            "telephone_number": "217-792-3218",
            "fax_number": "217-792-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY & JANE VONDERLIETH LIVING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2017-05-30",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. VP & CFO",
        "authorized_official_telephone_number": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "19976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The H & J Vonderlieth LVG CTR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Henry & Jane Vonderlieth Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pulaski, IL

Sources for this page

Verify at the official NPI Registry.