County of Fulton
Organization Active NPI Nursing Facility/Intermediate Care Facility · Cuba, IL
NPI 1497889554 · NPPES record last updated Nov 2, 2012
Key facts
- NPI
- 1497889554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 0014290 (IL)
- Legal business name
- COUNTY OF FULTON
- Practice address
- 625 East Monroe Street
Cuba, IL 61427-0200 - Phone
- (309) 785-5012
- Fax
- (309) 785-5376
- NPI assigned
- Mar 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Martha J Danielson, LNHA
- Title
- Administrator
- Phone
- (309) 785-5012
Corporate family (same tax ID) 1
Practitioners 2
-
Theresa Bankert, APN
-
Graciela Grammer, DDS
Affiliated clinicians 5
-
William Bailey, M.D.
-
Joshua Bowers, M.D.
-
Kenneth R. Krock, MD
Medicare Care Compare: Nursing home
- Listed as
- Clayberg, the
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- Jul 7, 2011
- Medicare certification status
- Active
- Certified beds
- 49 · 42.6 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Skilled nursing facility certification: CCN 146151
- Legal name
- COUNTY OF FULTON
- Doing business as
- CLAYBERG, THE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 7, 2011
- Last certification
- Apr 4, 2025
- Beds
- 49
- Ownership / control type
- County
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 6, 1969 in IL
- Enrollment address
- 625 E Monroe St
Cuba, IL 61427-5109 - Nursing home name
- CLAYBERG, THE
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| |
Trustee of the SNF | Oct 1, 2025 | |
| Adp of the SNF | Oct 1, 2025 | ||
| |
Trustee of the SNF | Dec 1, 2022 | |
| Adp of the SNF | Dec 1, 2022 | ||
| |
Trustee of the SNF | Dec 1, 2022 | |
| Adp of the SNF | Dec 1, 2022 | ||
| County of Fulton |
5% Or Greater Direct Ownership Interest | Jul 6, 1969 | 100% |
| Trustee of the SNF | Jul 6, 1969 | ||
| Indirect Ownership Interest | Jul 6, 1969 | ||
| |
Adp of the SNF | Jun 8, 2011 | |
| Indirect Ownership Interest | Jun 8, 2011 | ||
| Tammie Sue Denning |
Operational/Managerial Control | Jan 6, 2020 | |
| Adp of the SNF | Jan 6, 2020 | ||
| |
Trustee of the SNF | Dec 1, 2022 | |
| Adp of the SNF | Dec 1, 2022 | ||
| Direct Ownership Interest | Jan 1, 2020 | ||
| |
Trustee of the SNF | Dec 1, 2022 | |
| Adp of the SNF | Dec 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111103000069 | IL | Part a Provider - Skilled Nursing Facility | 3577574409 | Practice locations: Cuba, IL |
National Provider Directory
- Tax ID family
- County of Fulton
Locations
700 E Oak St
Canton, IL 61520
Phone (309) 647-1134
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 0014290 | IL | Yes |
| Skilled Nursing Facility | 314000000X | 0014290 | IL |
Addresses
Primary practice location
625 East Monroe Street
Cuba, IL 61427-0200
Mailing address
PO Box 200
625 East Monroe Street
Cuba, IL 61427-0200
Phone (309) 785-5012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370914241001 | Medicaid | IL |
Other names
- The Clayberg Fulton County Nursing Center
Other providers in Cuba, IL
- Kimberly Dawn Bordner
- Sydney K Collins
- Terrah L Cornell
- Bridgette Dennis
- Fulton County Comm Dist 3
- Graham Hospital Association
- Marcia Anne Heitz
- Megan Kathleen Holliger
All providers in Cuba, IL · Nursing Facility/Intermediate Care Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.