Healthcare Provider Details

I. General information

NPI: 1053579680
Provider Name (Legal Business Name): RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK LANE WEST
CLINTON IL
61727-2637
US

IV. Provider business mailing address

285 SOUTH FARNHAM STREET
GALESBURG IL
61401-5323
US

V. Phone/Fax

Practice location:
  • Phone: 217-935-8500
  • Fax: 217-935-8520
Mailing address:
  • Phone: 309-343-1550
  • Fax: 309-343-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD J WILSON
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 309-343-1550