Apostolic Christian Home of Roanoke Illinois Inc.

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

0021493 Issued in IL

Legal business name

APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.

Practice address

1102 W Randolph St
Roanoke, IL 61561-7528

Phone

(309) 923-2071

Fax

(309) 923-7919

NPI assigned

Sep 2, 2016

Last updated

Jan 24, 2017By 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

Mr. Richard D Isaia

Title

Administrator

Phone

(309) 923-2071

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Apostolic Christian Home of Roanoke Illinois Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Apostolic Christian Home of Roanoke Illinois Inc.

  • Skilled Nursing Facility
  • Roanoke, IL
  • NPI 1205918794
  NPD tax ID

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

{
    "created_epoch": "1472774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1770030074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615610530",
            "telephone_number": "309-923-2071",
            "fax_number": "309-923-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W RANDOLPH ST",
            "city": "ROANOKE",
            "state": "IL",
            "postal_code": "615617528",
            "telephone_number": "309-923-2071",
            "fax_number": "309-923-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-02",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "ISAIA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-923-2071",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "0021493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0021493",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Nicole Anderson, APP
• Apostolic Christian Home of Roanoke Illinois Inc.
• Jennifer A Bandy
• Brittany Baumgardner
• Carla Bolek, APRN
• Katelynn Elizabeth Bracht, APRN
• Jaclyn Lee Cakora

• Oxygen Equipment & Supplies (DME) in Roanoke, IL
• Providers in Roanoke, IL by specialty
• Oxygen Equipment & Supplies (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.