Provider Demographics
NPI:1245778810
Name:RIVER TO RIVER COMMUNITY OF ULLIN
Entity type:Organization
Organization Name:RIVER TO RIVER COMMUNITY OF ULLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTER HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-993-7533
Mailing Address - Street 1:P.O. BOX 1759
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 ULLIN AVE
Practice Address - Street 2:
Practice Address - City:ULLIN
Practice Address - State:IL
Practice Address - Zip Code:62992-1014
Practice Address - Country:US
Practice Address - Phone:618-845-9065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0583795310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0583795Medicaid