Organization · Type 2 NPI

Community Residential Centers Inc

Intellectual Disabilities Intermediate Care Facility · Galesburg, IL

NPI number 1043482979 Active

Practice location

239 South Cherry Street
Galesburg, IL 61401-4911

Call (309) 343-4101 Map

Fax (309) 343-4118

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	34066 (IL)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

Other intellectual disabilities intermediate care facility providers in Galesburg

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NPI record

NPI: 1043482979
Entity type: Organization (Type 2)
Issued: Apr 1, 2008
Last updated: Apr 20, 2008
Status: Active
Subpart: Yes of Community Residential Centers Inc

Other names

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ST Marys Square Living Center · doing business as

Authorized official

Mr. Ronald J Wilson
Authorized Agent
(309) 343-1550

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1043482979

Community Residential Centers Inc's National Provider Identifier is 1043482979, issued on Apr 1, 2008. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Galesburg, IL. The record was last updated on Apr 20, 2008.