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.

OrganizationActive

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)

Practice location

1030 Martin Luther King Dr

Centralia, IL 62801-3002

Phone: (618) 532-1833

Fax: (618) 532-1308

Street-level locationGet directions

More IL providers

Mailing address

1030 Martin Luther King Dr

Centralia, IL 62801-3002

Specialties & taxonomies

Skilled Nursing FacilityPrimary314000000XLicense 0045690 (IL)
Nursing & Custodial Care Facilities

Other names (DBA / former)

Doing business as: Fireside House of Centralia

Profile Score

Detailed profile(91/100 index)

A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.

Registry tenure38% of score
20 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.

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.

Provider details

Practice location

Mailing address

Specialties & taxonomies

Other names (DBA / former)

Profile Score

Registry dates

Frequently asked questions

Specialties & taxonomies

Other names (DBA / former)

Profile Score

Frequently asked questions