Prairie Village Supportive Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRAIRIE VILLAGE SUPPORTIVE LIVING LLC

Practice address

200 International Drive
Rantoul, IL 61866

Phone

(217) 892-2800

Fax

(217) 892-2833

NPI assigned

Oct 22, 2015

Organization subpart

Yes

Parent organization

PRAIRIE VILLAGE SUPPORTIVE LIVING LLCAs reported in NPPES

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

Authorized official

Name

Joellen Bleavins

Title

Vice President of Management Agent

Phone

(815) 935-1992

Specialties & licenses 2

Addresses

Part of

Prairie Village Supportive Living LLC

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

{
    "created_epoch": "1445472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1518339167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 INTERNATIONAL DRIVE",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "61866",
            "telephone_number": "217-892-2800",
            "fax_number": "217-892-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 INTERNATIONAL DRIVE",
            "city": "RANTOUL",
            "state": "IL",
            "postal_code": "61866",
            "telephone_number": "217-892-2800",
            "fax_number": "217-892-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE VILLAGE SUPPORTIVE LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRAIRIE VILLAGE SUPPORTIVE LIVING LLC",
        "enumeration_date": "2015-10-22",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "BLEAVINS",
        "authorized_official_first_name": "JOELLEN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF MANAGEMENT AGENT",
        "authorized_official_telephone_number": "815-935-1992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oladipupo O Osunbunmi, M.D.
• Alexander Pak
• Angela Perry, M,ED.
• Phillips Warner Rantoul, LLC - Rantoul Operations Series
• Prairie Living LLC
• Preferred Care LLC
• Jesus Presiado, APRN
• Promise Healthcare NFP
• Rantoul City School 137
• Rantoul Estates, LLC

• Assisted Living Facility in Rantoul, IL
• Providers in Rantoul, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; 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.