NPIMap

Organization Active NPI

Plymouth Place, Inc.

  • Skilled Nursing Facility
  • La Grange Park, IL
National Provider Identifier
1497884696
Registry record updated Jul 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0012898 Issued in IL
Legal business name
PLYMOUTH PLACE, INC.
Practice address
315 N la Grange Rd
La Grange Park, IL 60526-1903
Phone
(708) 482-6668
NPI assigned
Mar 5, 2007
Last updated
Jul 29, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2013

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

Authorized official

Name
Mr. Dale Lilburn
Title
C.E.O.
Phone
(708) 482-6668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0012898 IL Primary

Addresses

Primary practice location

315 N la Grange Rd
La Grange Park, IL 60526-1903

Mailing address

315 N. la Grange Road
La Grange Park, IL 60526-5695
Phone (708) 482-6668

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071103000136 IL Part A Provider - Skilled Nursing Facility 0345337572 Practice locations: La Grange Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497884696. Details of each certification follow.

Skilled nursing facility certification: CCN 146128

Legal name
PLYMOUTH PLACE, INC.
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Oct 22, 2008
Last certification
Jan 24, 2025
Beds
86
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
May 31, 1944 in IL
Enrollment address
315 N la Grange Rd
La Grange Park, IL 60526-1903
Nursing home name
PLYMOUTH PLACE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Plymouth PlaceCCN 146128 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Oct 22, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8676.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
James a Biere Individual Corporate Officer Jan 1, 2018 1%
Corporate DirectorCeo Jan 1, 2018 100%
Operational/Managerial ControlCeo Jan 1, 2018 100%
Mark Cloghessy Individual Corporate DirectorBoard Member May 1, 2018
Doris Bryant Individual Corporate DirectorDirector May 1, 2013
Jackie Terpstra Individual W-2 Managing EmployeeAdministrator Jan 1, 2018
Lawrence R Lapalio Individual Corporate DirectorBoard Member May 1, 2018
Mike Thiessen Individual Corporate DirectorBoard Member May 1, 2018
Elizabeth M Asperger Individual Corporate DirectorBoard Member May 1, 2018
Rebecca Mathis Individual Corporate OfficerCfo Jun 28, 2019
Thorn Serafin Individual Corporate DirectorBoard Member May 1, 2018
John Barrett Individual Corporate DirectorBoard Member May 1, 2018
Laura Weyrauch Individual Corporate DirectorBoard Member May 1, 2018
Marvin Baldwin Individual Corporate DirectorDirector May 1, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 9

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1497884696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N. LA GRANGE ROAD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605265695",
            "telephone_number": "708-482-6668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N LA GRANGE RD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261903",
            "telephone_number": "708-482-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH PLACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "LILBURN",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "708-482-6668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0012898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, IL

Sources for this page

Verify at the official NPI Registry.