MEDICARE: CONCEPTS PLUS 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	315P00000X	Intellectual Disabilities Intermediate Care Facility	43265	IL

General Provider Information

NPI Number	:	1649442773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPTS PLUS 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	:	1916 - 16TH STREET
Second Line	:
City	:	N CHICAGO
State	:	IL
Zip	:	60064-2008
Country	:	US
Telephone Number	:	847-473-2811
Fax Number	:	847-473-1943

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	04/20/2008

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