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MODERN CARE CONVALESCENT AND NURSING HOME
NPI 1396811550
Nursing Facility/Intermediate Care Facility in Jacksonville, IL

Active since November 28, 2006
1500 WEST WALNUT STREET, JACKSONVILLE, IL 62650(217) 245-4183(217) 243-2915 Get Directions Write a Review

NPPES record last updated: July 19, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Modern Care Convalescent And Nursing Home NPPES

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

MODERN CARE CONVALESCENT AND NURSING HOME (NPI 1396811550) is a healthcare organization registered as a nursing facility/intermediate care facility in Jacksonville, Illinois and active in the NPI registry since November 2006. The organization lists Gary L Potts, Manager, as its authorized official.

NPPES Registry Identity

NPI1396811550
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameCOVENANT CARE OF JACKSONVILLE LLC
Location Address1500 WEST WALNUT STREETJacksonville, IL 62650-1134
Mailing Address1200 Mountain Creek Road, Suite 350Chattanooga, TN 37405-6103 · (423) 870-3153 · Fax (423) 870-3196
Phone(217) 245-4183
Fax(217) 243-2915
Organization SubpartNo
Authorized OfficialGary L PottsManager · (423) 870-3153
Enumeration DateNovember 28, 2006
Last NPPES UpdateJuly 19, 2007
✔ NPI 1396811550 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
License✔ Licensed in IL · 1764855
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
Also ListedSkilled Nursing FacilityTaxonomy 314000000X · License 0047852 (IL)
1500 WEST WALNUT STREET, Jacksonville, IL 62650
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Other Names 1

Doing Business AsModern Care Convalescent And Nursing Home

Other Identifiers 2

Medicaid0036301IL
Medicare UPIN145060

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 Covenant Care Of Jacksonville LLC's NPI number?

The NPI number for Covenant Care Of Jacksonville LLC is 1396811550. It was assigned to this organization in the NPPES registry on November 28, 2006. The provider is doing business as Modern Care Convalescent And Nursing Home.

Where is Covenant Care Of Jacksonville LLC located?

Covenant Care Of Jacksonville LLC is located at 1500 West Walnut Street, Jacksonville, IL 62650. The listed phone number is (217) 245-4183.

What is Covenant Care Of Jacksonville LLC's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

When was this NPI record last updated?

The NPPES record for Covenant Care Of Jacksonville LLC was last updated on July 19, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.