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BONAN BROTHERS PROPERTIES PROJECT #3 LLC NPI 1134393754


NPI Information

NPI: 1134393754
Provider Name: BONAN BROTHERS PROPERTIES PROJECT #3 LLC

Doing Business As: HERITAGE WOODS OF CENTRALIA

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 14D2196677

Address:
2049 E MCCORD ST
CENTRALIA, IL
ZIP 62801
Phone: (618) 532-4590
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BONAN BROTHERS PROPERTIES PROJECT #3 LLC is an assisted living facility in Centralia, IL. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. BONAN BROTHERS PROPERTIES PROJECT #3 LLC NPI is 1134393754. The provider is registered as an organization entity type.
The provider Is Doing Business As Heritage Woods Of Centralia.

The provider's business location address is:

2049 E MCCORD ST
CENTRALIA, IL
ZIP 62801-727
Phone: (618) 532-4590

The provider's authorized official is Kim Ioerger .
The authorized official title is Rn/senior Administrator and has the following contact phone number (618) 532-4590.

The CLIA number assigned to this NPI record is 14D2196677 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/15/2008 and was last updated on 6/16/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========001MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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