Provider Demographics
NPI:1053320994
Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Entity type:Organization
Organization Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-343-1550
Mailing Address - Street 1:2170 W NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-7811
Mailing Address - Country:US
Mailing Address - Phone:815-233-2400
Mailing Address - Fax:815-297-0767
Practice Address - Street 1:2170 W NAVAJO DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-7811
Practice Address - Country:US
Practice Address - Phone:815-233-2400
Practice Address - Fax:815-297-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046839314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
146102Medicare Oscar/Certification