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PONTIAC SUPPORTIVE LIVING LLC NPI 1275076028


NPI Information

NPI: 1275076028
Provider Name: PONTIAC SUPPORTIVE LIVING, LLC

Doing Business As: POINTE AT PONTIAC

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

CLIA Number: 14D2177662

Address:
120 N DEERFIELD RD
PONTIAC, IL
ZIP 61764
Phone: (815) 844-6300
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PONTIAC SUPPORTIVE LIVING, LLC is an assisted living facility in Pontiac, 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. PONTIAC SUPPORTIVE LIVING, LLC NPI is 1275076028. The provider is registered as an organization entity type.
The provider Is Doing Business As Pointe At Pontiac.

The provider's business location address is:

120 N DEERFIELD RD
PONTIAC, IL
ZIP 61764-403
Phone: (815) 844-6300
Fax: (815) 844-6301

The provider's authorized official is Michael Stein .
The authorized official title is Managing Member and has the following contact phone number (773) 230-7762.

The CLIA number assigned to this NPI record is 14D2177662 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2016 and was last updated on 4/26/2021.


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 FacilityILLINOISYes

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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