NPIMap

Organization Active NPI

Friendship Manor Investors LLC

  • Skilled Nursing Facility
  • Nashville, IL
National Provider Identifier
1871582916
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0045922 Issued in IL
Legal business name
FRIENDSHIP MANOR INVESTORS LLC
Practice address
485 S Friendship Dr
Nashville, IL 62263-1363
Phone
(618) 327-3041
Fax
(618) 327-4001
NPI assigned
Oct 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mr. Mark Ide
Title
President
Phone
(317) 670-1577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0045922 IL Primary

Addresses

Primary practice location

485 S Friendship Dr
Nashville, IL 62263-1363

Mailing address

485 S Friendship Dr
Nashville, IL 62263-1363
Phone (618) 327-3041

Other identifiers 2

IdentifierTypeStateIssuer
371302197001OtherILMDS MEDICAID NUMBER
704OtherILBC BS OF ILLINOIS

Other names 1

  • FRIENDSHIP MANOR HEALTH CENTER Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0434412Friendship Manor Health Center485 S Friendship Dr, Nashville, IL 62263Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Friendship Manor Group LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1871582916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "485 S FRIENDSHIP DR",
            "city": "NASHVILLE",
            "state": "IL",
            "postal_code": "622631363",
            "telephone_number": "618-327-3041",
            "fax_number": "618-327-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 S FRIENDSHIP DR",
            "city": "NASHVILLE",
            "state": "IL",
            "postal_code": "622631363",
            "telephone_number": "618-327-3041",
            "fax_number": "618-327-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDSHIP MANOR INVESTORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "IDE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-670-1577",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0045922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDS MEDICAID NUMBER",
            "identifier": "371302197001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF ILLINOIS",
            "identifier": "704",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRIENDSHIP MANOR HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.