Community Residential Centers INC
Intermediate Care Facility, Intellectual Disabilities in Galesburg, IL. Organization (NPI-2).
NPI number1043482979
StatusActive
Last updated in NPPESApr 20, 2008
Details
- NPI
- 1043482979
- Entity type
- Organization (NPI-2)
- Legal business name
- Community Residential Centers INC
- Organization subpart
- Yes
- Enumeration date
- Apr 1, 2008
- Last updated
- Apr 20, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | 34066 | IL | Yes |
Other names
- St Marys Square Living Center (Doing Business As)
Practice location
239 South Cherry StreetGalesburg, IL 61401-4911
Phone 309-343-4101 · Fax 309-343-4118
Mailing address
285 South Farnham StreetGalesburg, IL 61401-5323
Phone 309-343-1550 · Fax 309-343-6318
Authorized official
Ronald J Wilson
Authorized Agent
3093431550
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All 8 Intellectual Disabilities Intermediate Care Facility providers in Galesburg · All 738 providers in Galesburg
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