Healthcare Provider Details

I. General information

NPI: 1932174000
Provider Name (Legal Business Name): RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 BECKER DR
PERU IL
61354
US

IV. Provider business mailing address

3230 BECKER DR
PERU IL
61354-1419
US

V. Phone/Fax

Practice location:
  • Phone: 815-220-1400
  • Fax: 815-220-1581
Mailing address:
  • Phone: 815-220-1400
  • Fax: 815-220-1581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0047316
License Number StateIL

VIII. Authorized Official

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