The Manor at Jerseyville Glen, LP

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

THE MANOR AT JERSEYVILLE GLEN, LP

Practice address

904B Estates Dr
Jerseyville, IL 62052-2377

Phone

(618) 639-9710

Fax

(618) 639-9715

NPI assigned

Oct 6, 2020

Organization subpart

No

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

Authorized official

Name

Cynthia Ann Rapp

Title

Chief Operating Officer

Phone

(618) 594-8581

Specialties & licenses 1

Addresses

Other names 1

• Blackberry Cottage Doing business as

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1871190504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904B ESTATES DR",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522377",
            "telephone_number": "618-639-9710",
            "fax_number": "618-639-9715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904B ESTATES DR",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522377",
            "telephone_number": "618-639-9710",
            "fax_number": "618-639-9715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MANOR AT JERSEYVILLE GLEN, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "RAPP",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "618-594-8581"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackberry Cottage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marilyn Kay Swearingin, CCC-SLP
• Sweeney & Toppmeyer Dentistry
• Sherman Carl Sweeney, DDS
• Emily Ann Talley, BT
• Shannon Tewell, CADC
• William H Thom, M.D.
• Sarah Elizabeth Thompson
• Jennifer Marie Timpe, PHARM.D.
• Anna Toney
• Randy Jerome Toppmeyer, DMD

• Assisted Living Facility in Jerseyville, IL
• Providers in Jerseyville, 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 Oct 6, 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.