NPI 1205014727

Glenwood House Residential Care, INC.

Organisation Intellectual Disabilities Intermediate Care Facility Streator, IL

Practice location

Address: 300 W 12th St, Streator, IL 61364-3301
Phone: (815) 673-1182
Fax: (815) 673-3231

Authorised official

Name: Ralph S Gomes
Title: President
Phone: (815) 673-1182

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 0037192 (IL)

Other Intermediate Care Facility, Intellectual Disabilities providers in Illinois →

Registry record

NPI: 1205014727
Entity type: Organization
NPI issued: 6 Feb 2008
Record last updated: 6 Feb 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.