Penta Nascent Corporation

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0036004 Issued in IL

Legal business name

PENTA NASCENT CORPORATION

Practice address

301 Roddy Rd
Salem, IL 62881-3836

Phone

(618) 548-0353

NPI assigned

Apr 20, 2007

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

Ceo

Phone

(618) 548-4561

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• LYNWOOD ESTATES Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G242

Legal name

LYNWOOD ESTATES

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

May 3, 1990

Last certification

Jan 31, 2025

Beds

16

Ownership / control type

Private (non-profit)

Facility address

301 Roddy Road
Salem, IL 62881

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

CLIA laboratory certificates

Tax ID family

Colonial Apts4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Penta Nascent Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1467670190
  NPD tax ID
• Penta Nascent Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1508086810
  NPD tax ID
• Penta Nascent Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1881814192
  NPD tax ID

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467670109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1690",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628019124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 RODDY RD",
            "city": "SALEM",
            "state": "IL",
            "postal_code": "628813836",
            "telephone_number": "618-548-0353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTA NASCENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-548-4561"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0036004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G242",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LYNWOOD ESTATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimber Dawn Organ
• Karlie Kaitlyn Orozco
• Thomas Henry Partain, L.O.T.
• Keri A Paulson, OTR/L
• Penta Group Inc.
• Physician Services Corp of Southern Illinois
• Erik B Pikas, M.D.
• Mary K Piper, FNP
• Haley Nicole Rambo, OD
• Josee Redpath, OTR

• Intellectual Disabilities Intermediate Care Facility in Salem, IL
• Providers in Salem, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.