Provider Demographics
NPI:1629196340
Name:THE RESIDENTIAL DEVELOPERS, INC.
Entity Type:Organization
Organization Name:THE RESIDENTIAL DEVELOPERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-398-0754
Mailing Address - Street 1:PO BOX 6525
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61826-6525
Mailing Address - Country:US
Mailing Address - Phone:217-398-0754
Mailing Address - Fax:
Practice Address - Street 1:310 W ENZ AVE
Practice Address - Street 2:
Practice Address - City:CISSNA PARK
Practice Address - State:IL
Practice Address - Zip Code:60924-9795
Practice Address - Country:US
Practice Address - Phone:815-547-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035279315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004OtherPROVIDER NUMBER