NPIMap

Organization Active NPI

Vandalia Terrace, LTD

  • Mental Illness Intermediate Care Facility
  • Skokie, IL
National Provider Identifier
1851359871
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Intermediate Care FacilityTaxonomy code 310500000X
License
1687983 Issued in IL
Legal business name
VANDALIA TERRACE, LTD
Practice address
3845 Oakton St
Skokie, IL 60076-3429
Phone
(847) 679-0100
Fax
(847) 679-0673
NPI assigned
May 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Byron Witt
Title
Administrator
Phone
(618) 283-1434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Intermediate Care Facility 310500000X 1687983 IL Primary

Addresses

Primary practice location

3845 Oakton St
Skokie, IL 60076-3429

Mailing address

3845 Oakton St
Skokie, IL 60076-3429
Phone (847) 679-0100

National Provider Directory

National Provider Directory
Tax ID family
Vandalia Terrace LTD2 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.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851359871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3845 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763429",
            "telephone_number": "847-679-0100",
            "fax_number": "847-679-0673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3845 OAKTON ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763429",
            "telephone_number": "847-679-0100",
            "fax_number": "847-679-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANDALIA TERRACE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WITT",
        "authorized_official_first_name": "BYRON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-283-1434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "IL",
            "license": "1687983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.