Active NPI
HCC-Healthcare Properties, LLC
- Skilled Nursing Facility
- Centralia, IL
National Provider Identifier
1861977019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- HCC-HEALTHCARE PROPERTIES, LLC
- Practice address
- 1030 Martin Luther King Dr
Centralia, IL 62801-3002 - Phone
- (618) 532-1308
- NPI assigned
- Oct 3, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Doug Mittleider
- Title
- President of Managing Member
- Phone
- (470) 282-3271
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
1030 Martin Luther King Dr
Centralia, IL 62801-3002
Mailing address
5174 McGinnis Ferry Rd Ste 195
Alpharetta, GA 30005-1792
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58266671301 | Medicaid | IL |
Other names 1
- Fireside House of Centralia
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181114001887 | IL | Part A Provider - Skilled Nursing Facility | 4688921273 | Practice locations: Centralia, IL |
Skilled nursing facility certification: CCN 145791
- Legal name
- HCC-HEALTHCARE PROPERTIES, LLC
- Doing business as
- FIRESIDE HOUSE OF CENTRALIA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- May 1, 1994
- Last certification
- Dec 12, 2024
- Beds
- 98
- Ownership / control type
- Individual
- Organization structure
- LLC
- Enrollment address
- 1030 Martin Luther King Dr
Centralia, IL 62801-3002 - Nursing home name
- FIRESIDE HOUSE OF CENTRALIA
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Fireside House of Centralia
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Individual
- Certified
- May 1, 1994
- Medicare certification status
- Active
- Certified beds
- 98
- Penalties (3 years)
- 3
National Provider Directory
National Provider Directory- Tax ID family
- Fireside House of Centralia
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Madisonville, TX
- NPI 1063900751
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
3050 Royal Blvd S
Ste 195
Alpharetta, GA 30022
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Adp of the SNF | Apr 1, 2007 | ||
| Sentry Healthcare Acquirors Inc | 5% Or Greater Direct Ownership Interest | Apr 11, 2018 | 100% |
| Doug K Mittleider | Corporate Officer | Jan 1, 2000 | |
| Kathy Berck | Operational/Managerial Control | Nov 1, 2018 | |
| Adp of the SNF | Feb 6, 2026 | ||
| Franklin Healthcare Inc | Operational/Managerial Control | Nov 1, 2018 | 100% |
| Adp of the SNF | Jan 14, 2026 |
Practitioners & affiliated clinicians
Affiliated clinicians 5
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Centralia, IL
- NPI 1760440580
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538524800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1538524800000",
"number": "1861977019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5174 MCGINNIS FERRY RD STE 195",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300051792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 MARTIN LUTHER KING DR",
"city": "CENTRALIA",
"state": "IL",
"postal_code": "628013002",
"telephone_number": "618-532-1308"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HCC-HEALTHCARE PROPERTIES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-03",
"last_updated": "2018-10-03",
"status": "A",
"authorized_official_last_name": "MITTLEIDER",
"authorized_official_first_name": "DOUG",
"authorized_official_title_or_position": "PRESIDENT OF MANAGING MEMBER",
"authorized_official_telephone_number": "470-282-3271"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "58266671301",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Fireside House of Centralia",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Centralia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.