Provider Demographics
NPI:1619146263
Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
Other - Org Name:FREEPORT REHAB AND HEALTH CARE CENTER
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 1:285 SOUTH FARNHAM STREET
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-343-1550
Mailing Address - Fax:309-343-2857
Practice Address - Street 1:900 SOUTH KIWANIS DRIVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032
Practice Address - Country:US
Practice Address - Phone:815-235-6196
Practice Address - Fax:815-235-5365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0049155314000000X
IL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0049155OtherLICENSE #
IL0049155OtherLICENSE #