NPIMap

Organization Active NPI

Caravilla Residential Centers, Inc

  • Skilled Nursing Facility
  • Mount Vernon, IL
National Provider Identifier
1932109485
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0039818 Issued in IL
Legal business name
CARAVILLA RESIDENTIAL CENTERS, INC
Practice address
1700 White St
Mount Vernon, IL 62864-4349
Phone
(618) 242-4075
Fax
(618) 242-4092
NPI assigned
Jul 27, 2005
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
Michael F Flanagan
Title
Receiver for, Corportate Attorney
Phone
(816) 444-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0039818 IL Primary

Addresses

Primary practice location

1700 White St
Mount Vernon, IL 62864-4349

Mailing address

1700 White St
Mount Vernon, IL 62864-4349
Phone (618) 242-4075

Other names 1

  • JEFFERSONIAN HEALTH CARE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Caravilla Residential Centers Inc3 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.

Locations

1700 White St
Mount Vernon, IL 62864
Phone (318) 242-4075

NPI Registry JSON

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

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932109485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 WHITE ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644349",
            "telephone_number": "618-242-4075",
            "fax_number": "618-242-4092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 WHITE ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644349",
            "telephone_number": "618-242-4075",
            "fax_number": "618-242-4092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARAVILLA RESIDENTIAL CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLANAGAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "RECEIVER FOR, CORPORTATE ATTORNEY",
        "authorized_official_telephone_number": "816-444-0900"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0039818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JEFFERSONIAN HEALTH CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, 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.