Presence Life Connections

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PRESENCE LIFE CONNECTIONS

Doing business as

Presence Our Lady of Victory Nursing Home

Practice address

20 Briarcliff LN
Bourbonnais, IL 60914-1665

Phone

(815) 937-2022

Fax

(815) 936-3231

NPI assigned

Sep 23, 2005

Organization subpart

Yes

Parent organization

PRESENCE LIFE CONNECTIONSAs reported in NPPES

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

Authorized official

Name

Michael Gordon

Title

Cfo

Phone

(708) 478-7911

Specialties & licenses 1

Addresses

Other names 1

• Presence Our Lady of Victory Nursing Home Doing business as

Part of

Presence Heritage Day Break

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456790400000",
    "number": "1568458693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18927 HICKORY CREEK DR STE 300",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488652",
            "telephone_number": "708-478-7911",
            "fax_number": "708-478-5324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BRIARCLIFF LN",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141665",
            "telephone_number": "815-937-2022",
            "fax_number": "815-936-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE LIFE CONNECTIONS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESENCE LIFE CONNECTIONS",
        "enumeration_date": "2005-09-23",
        "last_updated": "2016-03-01",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "708-478-7911"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Presence Our Lady of Victory Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Bourbonnais, IL
• Providers in Bourbonnais, 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 Mar 1, 2016; 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.