Organization · Type 2 NPI

Rave Residential Services, Inc.

Intellectual Disabilities Intermediate Care Facility · Jonesboro, IL

NPI number 1245423979 Active

Practice location

1370 State Route 127 S
Jonesboro, IL 62952-2488

Call (618) 833-3235 Map

Fax (618) 833-3237

Mailing address

1390 State Route 127 S
Jonesboro, IL 62952-2488

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	0040626 (IL)

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

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NPI record

NPI: 1245423979
Entity type: Organization (Type 2)
Issued: Aug 27, 2007
Last updated: Apr 20, 2008
Status: Active
Subpart: Yes of Rave Residential Services, Inc.

Other names

<unavail>
Peachtree Estates · doing business as

Authorized official

Mr. Gary L Griffith, L.N.H.A.
Administrator
(618) 833-5344

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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 1245423979

Rave Residential Services, Inc.'s National Provider Identifier is 1245423979, issued on Aug 27, 2007. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Jonesboro, IL. The record was last updated on Apr 20, 2008.