NPIMap

Organization Active NPI

Penta Nascent Corporation

Doing business as Colonial Apts.

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
National Provider Identifier
1881814192
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0038125 Issued in IL
Legal business name
PENTA NASCENT CORPORATION
Doing business as
Colonial Apts.
Practice address
920 W 4TH St
Centralia, IL 62801-5718
Phone
(618) 533-1199
NPI assigned
Apr 27, 2007
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
Georgia Miller
Title
Ceo
Phone
(618) 548-4561

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0038125 IL Primary

Addresses

Primary practice location

920 W 4TH St
Centralia, IL 62801-5718

Mailing address

PO Box 1690
Centralia, IL 62801-9124

Other identifiers 1

IdentifierTypeStateIssuer
14G093MedicaidIL

Other names 1

  • COLONIAL APTS. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Colonial Apts4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881814192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1690",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628019124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 W 4TH ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628015718",
            "telephone_number": "618-533-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENTA NASCENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-548-4561"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0038125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14G093",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COLONIAL APTS.",
            "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 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.