Southern Illinois Living Centers Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0033159 Issued in IL

Legal business name

SOUTHERN ILLINOIS LIVING CENTERS INC.

Practice address

111 E Illinois St
New Baden, IL 62265-1850

Phone

(618) 588-2066

Fax

(618) 588-4673

NPI assigned

Sep 15, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Michael Albert Brave

Title

Administrator

Phone

(618) 588-2066

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clitnon Manor Living Center Doing business as

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1639487408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E ILLINOIS ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651822",
            "telephone_number": "618-588-2066",
            "fax_number": "618-588-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E ILLINOIS ST",
            "city": "NEW BADEN",
            "state": "IL",
            "postal_code": "622651850",
            "telephone_number": "618-588-2066",
            "fax_number": "618-588-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS LIVING CENTERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-15",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "BRAVE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-588-2066",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0033159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371224393003",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clitnon Manor Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Royal Living Center Inc
• Lynn Kelly Ryder, LCPC
• Jennifer Sipula, PT
• Southern Illinois Community Support Services
• Southern Illinois Living Centers Inc.
• Jessa Kate Springer
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde
• Robert Stephens
• Tracy Hermanson
• Village of New Baden

• Intellectual Disabilities Intermediate Care Facility in New Baden, IL
• Providers in New Baden, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; 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.