OAK TERRACE HEALTHCARE CENTER, INC. (NPI# 1659497774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659497774 |
| Entity Type | Organization |
| Organization Name | OAK TERRACE HEALTHCARE CENTER, INC. |
| Practice Address |
1750 W Washington St Springfield IL 62702-4759 |
| Practice Telephone | 2177876466 |
| Practice Fax Number | 2177876846 |
| Mailing Telephone | 2177876466 |
| Mailing Fax Number | 2177876846 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-06-26 |
| Authorized Official Name | MR. KELLY E SMITH (OWNER OPERATOR) |
| Authorized Official Telephone | 9133624942 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 0023010 | IL | Nursing & Custodial Care Facilities |
| Street Address |
1750 W WASHINGTON ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740463074 | St. Joseph's Home of Springfield | Nursing Facility/Intermediate Care Facility | 3306 S 6th Street Rd, Springfield, IL 62703-4735 | 2007-12-10 |
| 1750468237 | Springfield Health Care Operating Company, LLC | Nursing Facility/Intermediate Care Facility | 404 E. Mccreight Ave., Springfield, OH 45503 | 2006-11-01 |
| 1932183134 | Christian Care Center of Springfield LLC | Nursing Facility/Intermediate Care Facility | 704 5th Ave E, Springfield, TN 37172-2604 | 2005-12-01 |
| 1053302695 | Southeast Colorado Hospital District | Nursing Facility/Intermediate Care Facility | 373 East 10th Avenue, Springfield, CO 81073-1622 | 2005-11-02 |
| 1902804305 | Springfield Terrace, Ltd | Nursing Facility/Intermediate Care Facility | 525 S Martin Luther King Jr Dr, Springfield, IL 62703-1317 | 2005-07-08 |
| 1114272374 | Select Rehab | Nursing Facility/Intermediate Care Facility | 1707 W Elfindale St, Springfield, MO 65807-1246 | 2012-07-13 |
| 1053627448 | Springfield Care Center, LLC | Nursing Facility/Intermediate Care Facility | 525 S Martin Luther King Jr Dr, Springfield, IL 62703-1317 | 2010-08-24 |
| 1598905838 | Springfield Healthcare Group Inc | Nursing Facility/Intermediate Care Facility | 404 E Mccreight Ave, Springfield, OH 45503-3653 | 2009-02-26 |
| 1538379581 | Memorial Medical Center | Nursing Facility/Intermediate Care Facility | 701 N 1st St, Springfield, IL 62702-3757 | 2007-05-22 |
| 1245447762 | Nancy M Paquette | Nursing Facility/Intermediate Care Facility | 136 William St, Springfield, MA 01105-2324 | 2007-05-16 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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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.