Provider Demographics
NPI:1649251059
Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Entity type:Organization
Organization Name:RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3222 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-7919
Mailing Address - Country:US
Mailing Address - Phone:217-431-1600
Mailing Address - Fax:217-431-3782
Practice Address - Street 1:3222 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-7919
Practice Address - Country:US
Practice Address - Phone:217-431-1600
Practice Address - Fax:217-431-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1676901314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
146090Medicare Oscar/Certification