Minooka Supportive Living Facility, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MINOOKA SUPPORTIVE LIVING FACILITY, LLC

Doing business as

Heritage Woods of Minooka

Practice address

701 Heritage Woods Dr
Minooka, IL 60447-8281

Phone

(815) 467-2837

Fax

(815) 467-2783

NPI assigned

Dec 21, 2016

Last updated

Dec 21, 2016By 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

Joellen Bleavins

Title

President of Management Agent

Phone

(815) 935-1992

Specialties & licenses 1

Addresses

Other names 1

• Heritage Woods of Minooka Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1482278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482278400000",
    "number": "1831634146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 HERITAGE WOODS DR",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604478281",
            "telephone_number": "815-467-2837",
            "fax_number": "815-467-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 HERITAGE WOODS DR",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604478281",
            "telephone_number": "815-467-2837",
            "fax_number": "815-467-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINOOKA SUPPORTIVE LIVING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-21",
        "last_updated": "2016-12-21",
        "status": "A",
        "authorized_official_last_name": "BLEAVINS",
        "authorized_official_first_name": "JOELLEN",
        "authorized_official_title_or_position": "PRESIDENT OF MANAGEMENT AGENT",
        "authorized_official_telephone_number": "815-935-1992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Woods of Minooka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Minooka, IL
• Providers in Minooka, 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 Dec 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.