Healthcare Provider Details

I. General information

NPI: 1992792147
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: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 LOWRY STREET
PITTSFIELD IL
62363-1700
US

IV. Provider business mailing address

610 LOWRY STREET
PITTSFIELD IL
62363-1700
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-5200
  • Fax: 217-285-5212
Mailing address:
  • Phone: 217-285-5200
  • Fax: 217-285-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0047944
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number47944
License Number StateIL

VIII. Authorized Official

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