Provider Demographics
NPI:1831194752
Name:MEADOWS MENNONITE RETIREMENT COMMUNITY ASSOCIATION, INC.
Entity type:Organization
Organization Name:MEADOWS MENNONITE RETIREMENT COMMUNITY ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BERTSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-747-2702
Mailing Address - Street 1:24588 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHENOA
Mailing Address - State:IL
Mailing Address - Zip Code:61726-9395
Mailing Address - Country:US
Mailing Address - Phone:309-747-2702
Mailing Address - Fax:309-747-2944
Practice Address - Street 1:24588 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHENOA
Practice Address - State:IL
Practice Address - Zip Code:61726-9395
Practice Address - Country:US
Practice Address - Phone:309-747-2702
Practice Address - Fax:309-747-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0011544313M00000X, 310400000X, 311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11544Medicaid
IL6006001Medicaid
IL6006001Medicaid
IL6006001Medicaid