SOUTHSIDE MANOR
NPI 1487788311
Intermediate Care Facility, Intellectual Disabilities in Decatur, IL

NPI Status: Active since March 15, 2007

Contact Information

729 S WEBSTER ST
DECATUR, IL
ZIP 62521
Phone: (217) 422-5478
Fax: (217) 422-2143

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About SOUTHSIDE MANOR

This page provides the complete NPI Profile along with additional information for Southside Manor, a provider established in Decatur, Illinois operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1487788311 assigned on March 2007. The practitioner's primary taxonomy code is 315P00000X with license number 0046961 (IL). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Southside Manor. The authorized official of this NPI record is Ms. Angela Cornell (President)

NPI
1487788311
Provider Legal Name
ALPHA OMEGA CONSULTING, INC.
Other Organization Name
SOUTHSIDE MANOR
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
729 S WEBSTER ST DECATUR, IL 62521
Location Phone
(217) 422-5478
Location Fax
(217) 422-2143
Mailing Address
729 S WEBSTER ST DECATUR, IL 62521
Mailing Phone
(217) 422-5478
Mailing Fax
(217) 422-2143
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-15-2007
Last Update Date
08-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Intermediate Care Facility, Intellectual Disabilities

Taxonomy Code
315P00000X
Type
Nursing & Custodial Care Facilities
License No.
0046961
License State
IL
Taxonomy Description
An intermediate care facility providing services for individuals with intellectual disabilities.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MS. ANGELA CORNELL

Authorized Official Title
PRESIDENT
Authorized Official Phone
(217) 422-4725

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1487788311
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
241671481632
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 6 + 7 + 1 + 4 + 8 + 1 + 6 + 3 + 2 + 24 = 69
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 69 = 11

The NPI number 1487788311 is valid because the calculated check digit 1 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1487788311, enumerated in the NPI registry as an "organization" on March 15, 2007

The provider is located at 729 S Webster St Decatur, Il 62521 and the phone number is (217) 422-5478

This medical organization specializes in Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X

This NPI record was last updated on March 15, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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