WC- Harrisburg Ops, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WC- HARRISBURG OPS, LLC

Doing business as

Brookstone of Harrisburg

Practice address

165 Ron Morse Dr
Harrisburg, IL 62946-5298

Phone

(618) 253-5870

Fax

(618) 253-5871

NPI assigned

Jan 8, 2015

Organization subpart

No

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

Authorized official

Name

Treva Aud

Title

Executive Director

Phone

(618) 253-5870

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookstone of Harrisburg Doing business as

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

{
    "created_epoch": "1420675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435449600000",
    "number": "1538557897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 RON MORSE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629465298",
            "telephone_number": "618-253-5870",
            "fax_number": "618-253-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 RON MORSE DR",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629465298",
            "telephone_number": "618-253-5870",
            "fax_number": "618-253-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WC- HARRISBURG OPS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-08",
        "last_updated": "2015-06-28",
        "status": "A",
        "authorized_official_last_name": "AUD",
        "authorized_official_first_name": "TREVA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-253-5870"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538557897",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookstone of Harrisburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Harrisburg, IL
• Providers in Harrisburg, 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 Jun 28, 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.