Bridgemark of Greenville, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0046680 Issued in IL

Legal business name

BRIDGEMARK OF GREENVILLE, LLC

Practice address

400 E Hillview Ave
Greenville, IL 62246-2607

Phone

(618) 664-1622

NPI assigned

Jul 7, 2005

Last updated

Apr 29, 2015By 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

Mr. Stephen P Miller

Title

Member

Phone

(312) 994-2306

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1386641272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E HILLVIEW AVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462607",
            "telephone_number": "618-664-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E HILLVIEW AVE",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622462607",
            "telephone_number": "618-664-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEMARK OF GREENVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "312-994-2306",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0046680",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0046680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE NUMBER",
            "identifier": "0046680",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bond County Treasurer
• Bond County Treasurer (Bond County Health Department)
• Bond County Treasurer (Bond County Health Department)
• Bond County Treasurer
• Michael M Bond, DO
• Crystal Mae Brown, APN
• Larry Dean Bruno, D.C.
• Charles Burns, MS,LCPC
• Crystal Marie Carmicheal, M.D.
• Marty Caudle, PA

• Skilled Nursing Facility in Greenville, IL
• Providers in Greenville, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; 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.