The Village at Mercy Creek

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

THE VILLAGE AT MERCY CREEK

Practice address

1501 Mercy Creek Dr
Normal, IL 61761-9597

Phone

(309) 268-1501

Fax

(309) 268-1498

NPI assigned

Sep 13, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Kathleen Kelly, RN, MS, LNHA

Title

Vice President of Clinical Services

Phone

(331) 318-5120

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568332800000",
    "number": "1598315376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 THERESA DR",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604392727",
            "telephone_number": "331-318-5120",
            "fax_number": "331-318-5210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MERCY CREEK DR",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617619597",
            "telephone_number": "309-268-1501",
            "fax_number": "309-268-1498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VILLAGE AT MERCY CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-13",
        "last_updated": "2019-09-13",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "331-318-5120",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MS, LNHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Normal, IL
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• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; 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.