Healthcare Provider Details

I. General information

NPI: 1225025596
Provider Name (Legal Business Name): UNLIMITED DEVELOPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 WILLIAMSON COUNTY PKWY
MARION IL
62959-5212
US

IV. Provider business mailing address

3116 WILLIAMSON COUNTY PKWY
MARION IL
62959-5212
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-8600
  • Fax: 618-993-5887
Mailing address:
  • Phone: 618-993-8600
  • Fax: 618-993-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number145841
License Number StateIL

VIII. Authorized Official

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