NPIMap

Organization Active NPI

Illinois Veterans Home at Quincy

  • Physical Disabilities Residential Treatment Facility
  • Quincy, IL
National Provider Identifier
1386708568
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
License
44107 Issued in IL
Legal business name
ILLINOIS VETERANS HOME AT QUINCY
Practice address
1707 N 12TH St
Quincy, IL 62301-1355
Phone
(217) 222-8641
Fax
(217) 222-8578
NPI assigned
Dec 21, 2006
Last updated
Jul 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

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

Authorized official

Name
Bruce L Vaca, LNHA
Title
Administrator
Phone
(217) 222-8641

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 0044107 IL
Physical Disabilities Residential Treatment Facility 320700000X 44107 IL Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1707 N 12TH St
Quincy, IL 62301-1355

Mailing address

1707 N 12TH St
BLDG 29M
Quincy, IL 62301-1355
Phone (217) 222-9487

Other identifiers 1

IdentifierTypeStateIssuer
00122001OtherBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603000715 IL Part B Supplier - Clinic/Group Practice 1355323361 Receives reassigned benefits from 10 practitioners
Practice locations: Quincy, IL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0980656Illinois Veterans Home at Quincy1707 North 12TH St, Quincy, IL 62301Certificate of waiverNov 28, 2026

National Provider Directory

National Provider Directory

Locations

1707 N 12th St
#29M
Quincy, IL 62301
Phone (217) 222-8641

1707 N 12th St
Bldg 29M
Quincy, IL 62301
Phone (217) 222-8641

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1386708568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 N 12TH ST",
            "address_2": "BLDG 29M",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623011355",
            "telephone_number": "217-222-9487",
            "fax_number": "217-222-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 N 12TH ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623011355",
            "telephone_number": "217-222-8641",
            "fax_number": "217-222-8578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VETERANS HOME AT QUINCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "VACA",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "217-222-8641",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IL",
            "license": "0044107",
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IL",
            "license": "44107",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00122001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.