Illinois Knights Templar Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0010058 Issued in IL

Legal business name

ILLINOIS KNIGHTS TEMPLAR HOME

Practice address

450 E Fulton St
Paxton, IL 60957-1716

Phone

(217) 379-2116

Fax

(217) 379-3000

NPI assigned

Jul 7, 2005

Last updated

Aug 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Underwood

Title

Cfo

Phone

(309) 823-7135

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502064000000",
    "number": "1952308744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E FULTON ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571716",
            "telephone_number": "217-379-2116",
            "fax_number": "217-379-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E FULTON ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571716",
            "telephone_number": "217-379-2116",
            "fax_number": "217-379-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS KNIGHTS TEMPLAR HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2017-08-07",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-823-7135"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0010058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Paxton, IL
• Providers in Paxton, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2017; 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.