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

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Jerry 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": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609823574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2653 W LAWRENCE AVE",
            "address_2": "SUITE 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": "2006-05-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "JERRY",
        "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": []
}

• Gordon John Mazzotti, R PH
• Richard R Mazzotti, RPH
• Roger S. McClintock, M.D.
• Katie Nicole McKenna, CRSS
• Meadow Manor, Inc
• Mental Health Centers of Central Illinois
• Mid-Illinois Dental Associates
• Mid-Illinois Dental Clinic, LLC
• Mid-State Special Education
• 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 Aug 22, 2020; 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.