Ltc of Illinois - Fireside, Inc.
NPI 1700819778 · Skilled Nursing Facility · Centralia, IL
Ltc of Illinois - Fireside, Inc. is a Skilled Nursing Facility organization in Centralia, IL (NPI 1700819778).
Provider details
- NPI number
- 1700819778
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Douglas Mittleider, President(770) 619-0866
- License
- 0045690 (IL)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 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
Mailing address
Other names (DBA / former)
- Doing business as
- Fireside House of Centralia
Registry dates
- Enumerated
- 2006-07-10
- Last updated
- 2008-04-20
Frequently asked questions
- What is Ltc of Illinois - Fireside, Inc.'s NPI number?
- Ltc of Illinois - Fireside, Inc.'s National Provider Identifier (NPI) is 1700819778, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Ltc of Illinois - Fireside, Inc.?
- Ltc of Illinois - Fireside, Inc. is classified in the NPPES registry as Skilled Nursing Facility (Nursing & Custodial Care Facilities).
- Where is Ltc of Illinois - Fireside, Inc. located?
- Ltc of Illinois - Fireside, Inc.'s practice location on file with NPPES is 1030 Martin Luther King Dr, Centralia, IL 62801-3002.
- What is Ltc of Illinois - Fireside, Inc.'s phone number?
- The practice phone number listed in the NPPES registry for Ltc of Illinois - Fireside, Inc. is (618) 532-1833.
- Who is the authorized official for Ltc of Illinois - Fireside, Inc.?
- The authorized official listed on Ltc of Illinois - Fireside, Inc.'s NPPES record is Douglas Mittleider, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Ltc of Illinois - Fireside, Inc.'s NPI active?
- Yes — Ltc of Illinois - Fireside, Inc.'s NPI (1700819778) is active in the NPPES registry as of the last update on 2008-04-20.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.