Meadow Manor, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0011528 Issued in IL

Legal business name

MEADOW MANOR, INC

Practice address

800 McAdam Dr
Taylorville, IL 62568-9634

Phone

(217) 824-2277

Fax

(217) 287-7763

NPI assigned

Oct 14, 2008

Organization subpart

No

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

Authorized official

Name

Jerry W Jennings

Title

Controller

Phone

(217) 787-8530

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223942400000",
    "number": "1568614238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2653 W LAWRENCE AVE STE B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627041115",
            "telephone_number": "217-787-8530",
            "fax_number": "217-787-9840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MCADAM DR",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625689634",
            "telephone_number": "217-824-2277",
            "fax_number": "217-287-7763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "217-787-8530"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0011528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley May
• Gordon John Mazzotti, R PH
• Richard R Mazzotti, RPH
• Roger S. McClintock, M.D.
• Katie Nicole McKenna, CRSS
• Meadow Manor, Inc
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• Mid-Illinois Dental Associates
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• Mid-State Special Education

• Skilled Nursing Facility in Taylorville, IL
• Providers in Taylorville, 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 Oct 14, 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.