Grand Victorian of Sterling Master Lessee, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

GRAND VICTORIAN OF STERLING MASTER LESSEE, LLC

Practice address

2705 Avenue E
Sterling, IL 61081-9016

Phone

(815) 622-2800

Fax

(815) 622-2801

NPI assigned

Oct 7, 2008

Last updated

Oct 7, 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

John Holtz

Title

Controller

Phone

(541) 747-3373

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1558512723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 CENTENNIAL LOOP",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017900",
            "telephone_number": "541-747-3373",
            "fax_number": "541-868-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 AVENUE E",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610819016",
            "telephone_number": "815-622-2800",
            "fax_number": "815-622-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND VICTORIAN OF STERLING MASTER LESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "541-747-3373"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Mitchell Gilbert
• Leah Gilmore
• Rajan Gopal, M.D.
• Suman Gopal, M.D.
• Angela M Gorzny, RN
• Todd William Gray, MD
• Emily Nicole Green
• Mackenzie Elise Grenter, MOT, OTR/L
• Jackie Greve, NP
• Karen Habben, O.T.

• Point of Service in Sterling, IL
• Providers in Sterling, IL by specialty
• Point of Service in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.