OrganizationActive
Fireside-Ltc, LLC
NPI 1346526134 · Skilled Nursing Facility · Centralia, IL
Provider details
- NPI number
- 1346526134
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Daren Douston, Member Cfo(678) 522-2436
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(80/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1030 Martin Luther King Dr
Centralia, IL 62801-3002
Phone: (678) 522-2436
Fax: (770) 663-4539
Street-level locationGet directions
Mailing address
10945 State Bridge Rd
Alpharetta, GA 30022-8164
Other names (DBA / former)
- Doing business as
- Fireside House of Centralia
Registry dates
- Enumerated
- 2011-10-25
- Last updated
- 2011-11-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.