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Organization
SULLIVAN HOUSE RESIDENTIAL CARE, INC.
Active
Organization
SULLIVAN HOUSE RESIDENTIAL CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH S GOMES (PRESIDENT)
(815) 433-5858
Entity
Organization
Contact information
Practice address
600 GROVER AVE, OTTAWA, IL 61350-4140
(815) 433-5858
(815) 673-3231
Mailing address
600 GROVER AVE, OTTAWA, IL 61350-4140
(815) 433-5858
(815) 673-3231
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0034140
IL
Other
Enumeration date
02/06/2008
Last updated
02/06/2008
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