Healthcare Provider Details

I. General information

NPI: 1245778810
Provider Name (Legal Business Name): RIVER TO RIVER COMMUNITY OF ULLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 ULLIN AVE
ULLIN IL
62992-1014
US

IV. Provider business mailing address

P.O. BOX 1759
MARION IL
62959
US

V. Phone/Fax

Practice location:
  • Phone: 618-845-9065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0583795
License Number StateIL

VIII. Authorized Official

Name: SHERRY BARTER HAMLIN
Title or Position: CEO
Credential:
Phone: 618-993-7533