Provider Demographics
NPI:1083692420
Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Entity Type:Organization
Organization Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Other - Org Name:MANOR COURT OF PRINCETON
Other - Org Type:Doing Business As
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 1:140 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-1878
Mailing Address - Country:US
Mailing Address - Phone:815-875-6600
Mailing Address - Fax:815-875-6005
Practice Address - Street 1:140 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-1878
Practice Address - Country:US
Practice Address - Phone:815-875-6600
Practice Address - Fax:815-875-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0047324314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371079626056Medicaid
IL371079626056Medicaid