Provider Demographics
NPI:1760479505
Name:UNLIMITED DEVELOPMENT INC.
Entity Type:Organization
Organization Name:UNLIMITED DEVELOPMENT INC.
Other - Org Name:UDI 10 PEKIN 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 1:1520 EL CAMINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6062
Mailing Address - Country:US
Mailing Address - Phone:309-353-1099
Mailing Address - Fax:866-534-7414
Practice Address - Street 1:1520 EL CAMINO DRIVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6062
Practice Address - Country:US
Practice Address - Phone:309-353-1099
Practice Address - Fax:866-534-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL47969314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371514555001Medicaid
145597Medicare Oscar/Certification