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	314000000X	Skilled Nursing Facility	47134	IL

General Provider Information

NPI Number	:	1588652044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL ALTERNATIVES OF ILLINOIS INC

Provider Business Mailing Address
First Line	:	1 PARK LANE WEST
Second Line	:
City	:	CLINTON
State	:	IL
Zip	:	61727
Country	:	US
Telephone Number	:	217-935-8500
Fax Number	:	217-935-8520

Provider Business Practice Location Address
First Line	:	1 PARK LANE WEST
Second Line	:
City	:	CLINTON
State	:	IL
Zip	:	61727
Country	:	US
Telephone Number	:	217-935-8500
Fax Number	:	217-935-8520

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/29/2010

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