Provider Demographics
NPI:1659366672
Name:UNLIMITED DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:UNLIMITED DEVELOPMENT, INC.
Other - Org Name:UDI 4 LEROY MANOR
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 1:509 S BUCK RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:IL
Mailing Address - Zip Code:61752-1683
Mailing Address - Country:US
Mailing Address - Phone:309-962-5000
Mailing Address - Fax:309-962-6227
Practice Address - Street 1:509 S BUCK RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:IL
Practice Address - Zip Code:61752-1683
Practice Address - Country:US
Practice Address - Phone:309-962-5000
Practice Address - Fax:309-962-6227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035733314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL145674Medicare Oscar/Certification