MEDICARE: RESIDENTIAL ALTERNATIVES OF ILLINOIS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1023285566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL ALTERNATIVES OF ILLINOIS INC

Provider Business Mailing Address
First Line	:	285 SOUTH FARNHAM STREET
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-5323
Country	:	US
Telephone Number	:	309-343-1550
Fax Number	:	309-343-6318

Provider Business Practice Location Address
First Line	:	140 NORTH SIXTH STREET
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-1878
Country	:	US
Telephone Number	:	815-875-6600
Fax Number	:	815-875-6005

Authorized Official
Title or Position	:	AUTHORIZED AGENT
Name	:	MR. RONALD J WILSON
Credential	:
Telephone Number	:	309-343-1550

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/14/2008

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Directions to “RESIDENTIAL ALTERNATIVES OF ILLINOIS INC ” Practice Location

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