Asta Care Center of Pontiac LLC

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

0043968 Issued in IL

Legal business name

ASTA CARE CENTER OF PONTIAC LLC

Practice address

300 W Lowell
Pontiac, IL 61764-2614

Phone

(815) 842-1181

NPI assigned

Nov 4, 2005

Last updated

May 10, 2013By 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

Michael Gillman

Title

President

Phone

(847) 742-8822

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1619968823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W LOWELL",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642614",
            "telephone_number": "815-842-1181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W LOWELL",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617642614",
            "telephone_number": "815-842-1181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASTA CARE CENTER OF PONTIAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "GILLMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-742-8822"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "IL",
            "license": "0043968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; 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.