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General NPI Number Information
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NPI Number | 1588652044
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Entity Type | Organization
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Legal Business Name | RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 1 PARK LANE WEST
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City | CLINTON
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State | IL
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Zip | 61727
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Country | US
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Telephone | 217-935-8500
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Fax | 217-935-8520
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Provider Business Mailing Address
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Address Line | 1 PARK LANE WEST
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City | CLINTON
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State | IL
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Zip | 61727
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Country | US
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Telephone | 217-935-8500
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Fax | 217-935-8520
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Authorized Official
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Title or Position | CFO
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Name | MR. RONALD J WILSON
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Credential |
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Telephone | 309-343-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 47134
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License Number State | IL
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