Sullivan Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SULLIVAN SENIOR LIVING LLC

Practice address

20 Courtyard Blvd
Sullivan, IL 61951-7001

Phone

(217) 728-4300

NPI assigned

Sep 18, 2024

Organization subpart

No

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

Authorized official

Name

Greg Echols

Title

Co-President of Management Agent

Phone

(779) 216-5849

Specialties & licenses 1

Addresses

Other names 1

• Heritage Woods of Sullivan Doing business as

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

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1497582902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E COURT ST STE 400",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013848",
            "telephone_number": "815-935-1992",
            "fax_number": "815-935-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 COURTYARD BLVD",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619517001",
            "telephone_number": "217-728-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "ECHOLS",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CO-PRESIDENT OF MANAGEMENT AGENT",
        "authorized_official_telephone_number": "779-216-5849"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Woods of Sullivan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Stutzman, CRSS
• Sullivan Comm Unit School District 300
• Sullivan Hco, LLC
• Sullivan Hco, LLC
• Sullivan Healthcare & Senior Living LLC
• Nell Sundra
• Mohammad Tabatabaei, P.A.-C
• Thomas C. Best, O.D.
• Lisa V Thomas
• Kylie Tibbetts

• All providers in Sullivan, IL
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.