Woodridge of Ponitac LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WOODRIDGE OF PONITAC LLC

Practice address

120 North Deerfield Road
Pontiac, IL 61764

Phone

(815) 844-2100

Fax

(815) 844-2103

NPI assigned

Dec 17, 2008

Organization subpart

No

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

Authorized official

Name

Marshall A Mauer

Title

Manager

Phone

(815) 844-2100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229472000000",
    "number": "1871739185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 NORTH DEERFIELD ROAD",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-2100",
            "fax_number": "815-844-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NORTH DEERFIELD ROAD",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "61764",
            "telephone_number": "815-844-2100",
            "fax_number": "815-844-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODRIDGE OF PONITAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A",
        "authorized_official_last_name": "MAUER",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "815-844-2100"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Wichman
• Isaac Wicker, BS
• Josie Wiles
• Alison Christine Wissen, MS, CF-SLP/L
• Sharon R. Wissler, CNP
• Carly Ann Zimmer, MS, RD, LDN

• Assisted Living Facility in Pontiac, IL
• Providers in Pontiac, 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 17, 2008; 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.