NPIMap

Organization Active NPI

Pinnacle Opportunities Inc

Doing business as Collins Square

  • Intellectual Disabilities Intermediate Care Facility
  • Bradley, IL
National Provider Identifier
1922270370
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
48004 Issued in IL
Legal business name
PINNACLE OPPORTUNITIES INC
Doing business as
Collins Square
Practice address
145 S Crosswell Avenue
Bradley, IL 60915-2026
Phone
(815) 932-8668
Fax
(815) 932-9889
NPI assigned
Mar 26, 2008
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PINNACLE OPPORTUNITIES INCAs reported in NPPES

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. Ronald J Wilson
Title
Authorized Agent
Phone
(309) 343-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 48004 IL Primary

Addresses

Primary practice location

145 S Crosswell Avenue
Bradley, IL 60915-2026

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323
Phone (309) 343-1550

Other names 1

  • Collins Square Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922270370. Details of each certification follow.

  • CCN 14G135 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G135

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COLLINS SQUARE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 19, 1987
Last certification
Nov 21, 2024
Beds
16
Ownership / control type
Private (non-profit)
Facility address
145 South Crosswell Avenue
Bradley, IL 60915

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Opportunities Inc11 organizations share this tax ID, including this one
Part of
Pinnacle Opportunities Inc

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

145 S Crosswell Ave
Bradley, IL 60915
Phone (815) 932-8668

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1922270370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 SOUTH FARNHAM STREET",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614015323",
            "telephone_number": "309-343-1550",
            "fax_number": "309-343-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S CROSSWELL AVENUE",
            "city": "BRADLEY",
            "state": "IL",
            "postal_code": "609152026",
            "telephone_number": "815-932-8668",
            "fax_number": "815-932-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE OPPORTUNITIES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINNACLE OPPORTUNITIES INC",
        "enumeration_date": "2008-03-26",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "309-343-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "48004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Collins Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bradley, IL

Sources for this page

Verify at the official NPI Registry.