Evenglow Lodge

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0008425 Issued in IL

Legal business name

EVENGLOW LODGE

Practice address

215 E Washington St
Pontiac, IL 61764-2011

Phone

(815) 844-6131

Fax

(815) 842-3558

NPI assigned

May 19, 2006

Last updated

Apr 17, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark Hovren

Title

President Ceo

Phone

(815) 844-6131

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558314302. Details of each certification follow.

• CCN 146095 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 146095

Legal name

EVENGLOW LODGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Dec 15, 2005

Last certification

Sep 5, 2024

Beds

214 (48 certified)

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Incorporated

Mar 6, 1957 in IL

Enrollment address

215E Washington St
Pontiac, IL 61764-2011

Nursing home name

EVENGLOW LODGE

Listed as

Evenglow LodgeCCN 146095 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

4 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Dec 15, 2005

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4825.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Owners & managing parties with NPI records 1

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

• Darrin Ray, MD

  • Family Medicine Physician
  • Gibson City, IL
  • NPI 1679785778

  5% Or Greater Indirect Ownership Interest, Adp of the SNF, Indirect Ownership Interest

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• John Rinker, DO

  • Family Medicine Physician
  • Pontiac, IL
  • NPI 1255449393

  Nursing home

  Care Compare affiliation
• John Michael Rinker, M.D.

  • Internal Medicine Physician
  • Pontiac, IL
  • NPI 1316173636

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1558314302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642011",
            "telephone_number": "815-844-6131",
            "fax_number": "815-842-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642011",
            "telephone_number": "815-844-6131",
            "fax_number": "815-842-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVENGLOW LODGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "HOVREN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "815-844-6131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0008425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146095",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gloria J Duy, RD, LDN
• Kimber Marian Edelman, COTA/L
• Junior Lynn Elling, OTR/L, MHA
• Jennifer Elzey, BS
• Kaitlyn Elzey, RSA
• Family Eye Care of Pontiac, LLC
• Andrew John Farraher, CNP
• Ashley Nicole Fauser
• Brooke Fehr, MSW
• Angelito Fernandez

• Skilled Nursing Facility in Pontiac, IL
• Providers in Pontiac, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.