Beardstown Supportive Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BEARDSTOWN SUPPORTIVE LIVING LLC

Practice address

8570 Saint Lukes Dr
Beardstown, IL 62618-9200

Phone

(217) 323-1860

NPI assigned

Jul 27, 2023

Last updated

Jul 27, 2023By 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

Shai Berdugo

Title

Authorized Official

Phone

(217) 323-1860

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1689355109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 ROUTE 70",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087234042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8570 SAINT LUKES DR",
            "city": "BEARDSTOWN",
            "state": "IL",
            "postal_code": "626189200",
            "telephone_number": "217-323-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEARDSTOWN SUPPORTIVE LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-27",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "BERDUGO",
        "authorized_official_first_name": "SHAI",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "217-323-1860"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary Agnes Bigelow, O.D.

• Assisted Living Facility in Beardstown, IL
• Providers in Beardstown, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; 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.