NPIMap

Organization Active NPI

Illinois Veterans Home at Manteno

  • Physical Disabilities Residential Treatment Facility
  • Manteno, IL
National Provider Identifier
1831248228
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
License
0042218 Issued in IL
Legal business name
ILLINOIS VETERANS HOME AT MANTENO
Practice address
1 Veterans Dr
Manteno, IL 60950-9466
Phone
(815) 468-6581
Fax
(815) 468-7001
NPI assigned
Jan 9, 2007
Last updated
Jul 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

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

Authorized official

Name
Reginald L Booker, LNHA
Title
Administrator
Phone
(815) 468-6581

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 0042218 IL
Physical Disabilities Residential Treatment Facility 320700000X 0042218 IL Primary
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

1 Veterans Dr
Manteno, IL 60950-9466

Mailing address

1 Veterans Dr
BLDG a-2M
Manteno, IL 60950-9466
Phone (217) 222-9487

Other identifiers 1

IdentifierTypeStateIssuer
04621430OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040127000854 IL Part B Supplier - Clinic/Group Practice 1658274881 Receives reassigned benefits from 7 practitioners
Practice locations: Manteno, IL
O20110224000635 IL DME Supplier - Nursing Facility 1658274881 Practice locations: Manteno, IL

National Provider Directory

National Provider Directory

Locations

1 Veterans Dr
Bldg A2M
Manteno, IL 60950

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279152000000",
    "number": "1831248228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "address_2": "BLDG A-2M",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609509466",
            "telephone_number": "217-222-9487",
            "fax_number": "217-222-8578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609509466",
            "telephone_number": "815-468-6581",
            "fax_number": "815-468-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VETERANS HOME AT MANTENO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2010-07-15",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-468-6581",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "IL",
            "license": "0042218",
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IL",
            "license": "0042218",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "04621430",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteno, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.