CLINTON MANOR LIVING CENTER
NPI 1174518278
Skilled Nursing Facility in New Baden, IL

Active since September 14, 2005CLIA 14D0434424 · Waiver
111 E ILLINOIS ST, NEW BADEN, IL 62265(618) 588-4924(618) 588-4673 Get Directions Write a Review

NPPES record last updated: November 9, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Clinton Manor Living Center NPPES

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

CLINTON MANOR LIVING CENTER (NPI 1174518278) is a healthcare organization registered as a skilled nursing facility in New Baden, Illinois and active in the NPI registry since September 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Michael A Brave, Vice President Administrator, as its authorized official.

NPPES Registry Identity

NPI1174518278
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSOUTHERN ILLINOIS LIVING CENTERS INC.
Location Address111 E ILLINOIS STNew Baden, IL 62265-1850
Mailing Address111 E Illinois StNew Baden, IL 62265-1850 · (618) 588-2066 · Fax (618) 588-4673
Fax(618) 588-4673
Organization SubpartNo
Authorized OfficialMichael A BraveVice President Administrator · (618) 588-2066
Enumeration DateSeptember 14, 2005
Last NPPES UpdateNovember 9, 2011
NPI 1174518278 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IL · 0033159
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Also ListedIntermediate Care Facility, Intellectual DisabilitiesTaxonomy 315P00000X · License 0033159 (IL)
111 E ILLINOIS ST, New Baden, IL 62265

Other Names 1

Doing Business AsClinton Manor Living Center

Other Identifiers 5

Medicaid=========003IL
Medicaid=========001IL
Medicare OSCAR/certification146025IL
Other0033159IL · Idph License Number
Medicaid=========002IL

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 14D0434424

Clinton Manor Living Center · New Baden, IL
Active · expires Aug 31, 2026
CLIA Number14D0434424
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorErin Fancher Gagen
Laboratory Phone(618) 588-4924
Laboratory LocationClinton Manor Living Center111 E Illinois St, New Baden, IL 62265
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 6

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

Intermediate Care Facility, Intellectual Disabilities
111 E ILLINOIS ST
NEW BADEN, IL 62265
Physical Therapy Assistant
111 E ILLINOIS ST
NEW BADEN, IL 62265
Physical Therapy Assistant
111 E ILLINOIS ST
NEW BADEN, IL 62265
Occupational Therapist
111 E ILLINOIS ST
NEW BADEN, IL 62265
Speech-Language Pathologist
111 E ILLINOIS ST
NEW BADEN, IL 62265
Physical Therapy Assistant
111 E ILLINOIS ST
NEW BADEN, IL 62265

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 Southern Illinois Living Centers Inc.'s NPI number?

The NPI number for Southern Illinois Living Centers Inc. is 1174518278. It was assigned to this organization in the NPPES registry on September 14, 2005. The provider is doing business as Clinton Manor Living Center.

Where is Southern Illinois Living Centers Inc. located?

Southern Illinois Living Centers Inc. is located at 111 E Illinois St, New Baden, IL 62265. The listed phone number is (618) 588-4924.

What is Southern Illinois Living Centers Inc.'s specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Southern Illinois Living Centers Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0434424) is associated with this NPI, valid through August 31, 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 Southern Illinois Living Centers Inc. was last updated on November 9, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.