FIRESIDE HOUSE OF CENTRALIA
NPI 1700819778
Skilled Nursing Facility in Centralia, IL

Active since July 10, 2006
1030 MARTIN LUTHER KING DR, CENTRALIA, IL 62801(618) 532-1833(618) 532-1308 Get Directions Write a Review

NPPES record last updated: April 20, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Fireside House Of Centralia NPPES

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

FIRESIDE HOUSE OF CENTRALIA (NPI 1700819778) is a healthcare organization registered as a skilled nursing facility in Centralia, Illinois and active in the NPI registry since July 2006. The organization lists Douglas K Mittleider, President, as its authorized official.

NPPES Registry Identity

NPI1700819778
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameLTC OF ILLINOIS - FIRESIDE, INC.
Location Address1030 MARTIN LUTHER KING DRCentralia, IL 62801-3002
Mailing Address1030 Martin Luther King DrCentralia, IL 62801-3002 · (618) 532-1833 · Fax (618) 532-1308
Fax(618) 532-1308
Organization SubpartNo
Authorized OfficialDouglas K MittleiderPresident · (770) 619-0866
Enumeration DateJuly 10, 2006
Last NPPES UpdateApril 20, 2008
NPI 1700819778 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in IL · 0045690
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.
1030 MARTIN LUTHER KING DR, Centralia, IL 62801

Other Names 1

Doing Business AsFireside House Of Centralia

Other Identifiers 2

Medicare ID-Type Unspecified14-5791
Medicaid=========01IL

Other Providers at the Same Location NPPES 2

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

Skilled Nursing Facility
1030 MARTIN LUTHER KING DR
CENTRALIA, IL 62801
Skilled Nursing Facility
1030 MARTIN LUTHER KING DR
CENTRALIA, IL 62801

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 Ltc Of Illinois - Fireside, Inc.'s NPI number?

The NPI number for Ltc Of Illinois - Fireside, Inc. is 1700819778. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Fireside House Of Centralia.

Where is Ltc Of Illinois - Fireside, Inc. located?

Ltc Of Illinois - Fireside, Inc. is located at 1030 Martin Luther King Dr, Centralia, IL 62801. The listed phone number is (618) 532-1833.

What is Ltc Of Illinois - Fireside, Inc.'s specialty?

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

When was this NPI record last updated?

The NPPES record for Ltc Of Illinois - Fireside, Inc. was last updated on April 20, 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.