NPIMap

Organization Active NPI

Pioneer Concepts Inc

Doing business as Carole Lane Terrace

  • Intellectual Disabilities Intermediate Care Facility
  • Sauk Village, IL
National Provider Identifier
1497928618
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
47977 Issued in IL
Legal business name
PIONEER CONCEPTS INC
Doing business as
Carole Lane Terrace
Practice address
1641 Carole Lane
Sauk Village, IL 60411-4990
Phone
(708) 758-8756
Fax
(708) 758-1817
NPI assigned
Apr 9, 2008
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PIONEER CONCEPTS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Ronald J Wilson
Title
Authorized Agent
Phone
(309) 343-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 47977 IL Primary

Addresses

Primary practice location

1641 Carole Lane
Sauk Village, IL 60411-4990

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323
Phone (309) 343-1550

Other names 1

  • Carole Lane Terrace Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497928618. Details of each certification follow.

  • CCN 14G217 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G217

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CAROLE LANE TERRACE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 30, 1989
Last certification
Sep 6, 2024
Beds
16
Ownership / control type
Private (non-profit)
Most recent change of ownership
Mar 21, 2019
Facility address
1641 Carole Lane
Sauk Village, IL 60411

National Provider Directory

National Provider Directory
Tax ID family
Pioneer Concepts Inc13 organizations share this tax ID, including this one
Part of
Pioneer Concepts Inc

Other organizations with this tax ID 12

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

Locations

1641 Carole Ln
Sauk Village, IL 60411
Phone (708) 758-8756

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1497928618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 SOUTH FARNHAM STREET",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614015323",
            "telephone_number": "309-343-1550",
            "fax_number": "309-343-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 CAROLE LANE",
            "city": "SAUK VILLAGE",
            "state": "IL",
            "postal_code": "604114990",
            "telephone_number": "708-758-8756",
            "fax_number": "708-758-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER CONCEPTS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PIONEER CONCEPTS INC",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "309-343-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "47977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carole Lane Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sauk Village, IL

Sources for this page

Verify at the official NPI Registry.