Provider Demographics
NPI:1114915410
Name:DSI PARTNERS LLC
Entity Type:Organization
Organization Name:DSI PARTNERS LLC
Other - Org Name:LYNNCREST MANOR OF PARIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-465-5395
Mailing Address - Street 1:310 S EADS AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1938
Mailing Address - Country:US
Mailing Address - Phone:217-465-5395
Mailing Address - Fax:217-463-7905
Practice Address - Street 1:310 S EADS AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1938
Practice Address - Country:US
Practice Address - Phone:217-465-5395
Practice Address - Fax:217-463-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1615469314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid
145466Medicare Oscar/Certification
IL145466Medicare ID - Type Unspecified