NPI 1043482979

Community Residential Centers INC

Organisation Intellectual Disabilities Intermediate Care Facility Galesburg, IL

Practice location

Address: 239 South Cherry Street, Galesburg, IL 61401-4911
Phone: (309) 343-4101
Fax: (309) 343-4118
Mailing address: 285 South Farnham Street, Galesburg, IL 61401-5323

Authorised official

Name: Ronald J Wilson
Title: Authorized Agent
Phone: (309) 343-1550

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 34066 (IL)

Other Intermediate Care Facility, Intellectual Disabilities providers in Illinois →

Registry record

NPI: 1043482979
Entity type: Organization
NPI issued: 1 Apr 2008
Record last updated: 20 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.