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GRAND VICTORIAN OF SYCAMORE, LLC
NPI 1154527810
Point of Service in Sycamore, IL

Active since June 21, 2007CLIA 14D2195801 · Waiver
1440 SOMONAUK ST, SYCAMORE, IL 60178(815) 895-1900(815) 895-1901 Get Directions Write a Review

NPPES record last updated: May 13, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Grand Victorian Of Sycamore, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND VICTORIAN OF SYCAMORE, LLC (NPI 1154527810) is a healthcare organization registered as a point of service in Sycamore, Illinois and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through October 12, 2026 and lists John Holtz, Controller, as its authorized official.

NPPES Registry Identity

NPI1154527810
Entity TypeOrganization
Primary Taxonomy305S00000X
Legal Business NameGRAND VICTORIAN OF SYCAMORE, LLC
Location Address1440 SOMONAUK STSycamore, IL 60178-2916
Mailing Address78 Centennial LoopEugene, OR 97401-7900 · (541) 747-3373 · Fax (541) 747-0673
Phone(815) 895-1900
Fax(815) 895-1901
Organization SubpartNo
Authorized OfficialJohn HoltzController · (541) 747-3373
Enumeration DateJune 21, 2007
Last NPPES UpdateMay 13, 2008
✔ NPI 1154527810 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPoint of ServiceManaged Care Organizations
Taxonomy Code305S00000X
Definition
This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.
1440 SOMONAUK ST, Sycamore, IL 60178
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2195801

Grand Victorian Of Sycamore · Sycamore, IL
Active · expires Oct 12, 2026
CLIA Number14D2195801
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 13, 2024
Certificate Expiration DateOctober 12, 2026
Laboratory DirectorMary A. Bratthauer
Laboratory Phone(815) 895-1900
Laboratory LocationGrand Victorian Of Sycamore1440 Somonauk St, Sycamore, IL 60178
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GRAND VICTORIAN OF SYCAMORE
Assisted Living Facility
1440 SOMONAUK ST
SYCAMORE, IL 60178
Dekalb County (815) 895-1900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grand Victorian Of Sycamore, LLC's NPI number?

The NPI number for Grand Victorian Of Sycamore, LLC is 1154527810. It was assigned to this organization in the NPPES registry on June 21, 2007.

Where is Grand Victorian Of Sycamore, LLC located?

Grand Victorian Of Sycamore, LLC is located at 1440 Somonauk St, Sycamore, IL 60178. The listed phone number is (815) 895-1900.

What is Grand Victorian Of Sycamore, LLC's specialty?

The primary specialty registered for this NPI is Point of Service with taxonomy code 305S00000X.

Does Grand Victorian Of Sycamore, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2195801) is associated with this NPI, valid through October 12, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Grand Victorian Of Sycamore, LLC was last updated on May 13, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.