PENTA GROUP INC. NPI 1932246071

NPI Information

  • NPI: 1932246071
  • Provider Name: PENTA GROUP INC.
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Other Name: BRYAN MANOR
  • CLIA Number: 14D1032087
  • Address: 2150 E MCCORD ST
    CENTRALIA, IL
    ZIP 62801
  • Phone: (618) 918-3770

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NPI Details

PENTA GROUP INC. is an intermediate care facility mentally retarded in Centralia, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PENTA GROUP INC. NPI is 1932246071. The provider is registered as an organization entity type.
The provider Other Name Is Bryan Manor.

The provider's business location address is:

2150 E MCCORD ST
CENTRALIA, IL
ZIP 62801-730
Phone: (618) 918-3770

The provider's authorized official is Georgia Miller .
The authorized official title is Administrator and has the following contact phone number (618) 918-3770.

The CLIA number assigned to this NPI record is 14D1032087 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2007 and was last updated on 10/18/2010.

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
1315P00000XIntermediate Care Facility, Intellectual Disabilities0033373ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
114G037MEDICAIDILLINOIS

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: 11/21/2025

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