SHAMROCK SERVICES, LLC (NPI# 1306990601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306990601 |
| Entity Type | Organization |
| Organization Name | SHAMROCK SERVICES, LLC |
| Practice Address |
4219 Lincolnshire Dr Mount Vernon IL 62864-2157 |
| Mailing Address |
Po Box 2369 Mount Vernon IL 62864-0046 |
| Practice Telephone | 6182422169 |
| Practice Fax Number | 6182429770 |
| Mailing Telephone | 6182447701 |
| Mailing Fax Number | 6182447704 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | BRIDGET P MCDONAGH (PARTNER) |
| Authorized Official Telephone | 6182447701 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
94S227 | IL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | CILA LICENSE | 94S227 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SHAMROCK SERVICES, LLC | 340 Trinity Rd, Dublin, GA 31021-0432 |
| Street Address |
4219 LINCOLNSHIRE DR |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2157 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669524401 | Developmental Planning & Services Inc | Intermediate Care Facility, Mentally Retarded | 4219 Lincolnshire Dr, Mount Vernon, IL 62864-2157 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528428547 | J & K Adult Care Home | Custodial Care Facility | 233 S 5th Ave, Mount Vernon, NY 10550-3829 | 2016-03-03 |
| 1992172142 | Sean Hamil | Custodial Care Facility | 437 S 2nd Ave, Mount Vernon, NY 10550-2881 | 2015-08-24 |
| 1457561623 | Cascade Living Group | Custodial Care Facility | 3807 E College Way, Mount Vernon, WA 98273-9182 | 2007-05-23 |
| 1326110594 | Jjr Enterprises Inc | Custodial Care Facility | 2025 Broadway St Ste B, Mount Vernon, IL 62864-2935 | 2006-11-14 |
| 1669479150 | Community Residence, Inc. | Custodial Care Facility | 1425b S Landrum St, Mount Vernon, MO 65712-1912 | 2005-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962954099 | State of Illinois Department of Human Services | Custodial Care Facility | 10724 S Indiana Ave, Chicago, IL 60628-3615 | 2016-10-24 |
| 1215302583 | Epilepsy Foundation of Greater Southern Illinois | Custodial Care Facility | 3515 N Belt W, Belleville, IL 62226-5944 | 2015-12-11 |
| 1316334907 | Dean Homecare LLC | Custodial Care Facility | 6604 N Ashland Ave, 3 J, Chicago, IL 60626-4151 | 2015-04-21 |
| 1881015329 | St Clair Supportive Living Lp | Custodial Care Facility | 921 Knollwood Village Rd, Caseyville, IL 62232-1808 | 2013-12-31 |
| 1700100971 | Good Shepherd Manor, Inc | Custodial Care Facility | 4129 N State Routes 1 & 17, Momence, IL 60954-0260 | 2010-03-17 |
| 1386895381 | Rickcare, LLC | Custodial Care Facility | 2490 County Road 550 E, Dewey, IL 61840-9725 | 2008-10-08 |
| 1689844912 | Parents and Friends of The Community Integration Services | Custodial Care Facility | 212 S. 32nd St, Belleville, IL 62226 | 2008-03-03 |
| 1568630390 | Halsted Shelter Care | Custodial Care Facility | 16044 Halsted St, Harvey, IL 60426-5201 | 2008-02-14 |
| 1003805672 | Westmont Convalescent Center | Custodial Care Facility | 6501 S Cass Ave, Westmont, IL 60559-3200 | 2005-10-17 |
| 1720613748 | Cass County Mental Health Assoc | Custodial Care Facility | 121 E 2nd St, Beardstown, IL 62618-1263 | 2020-03-10 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.