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Organization
RAVE RESIDENTIAL SERVICES, INC
Active
Organization
RAVE RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY L GRIFFITH L.N.H.A. (ADMINISTRATOR)
(618) 833-5344
Entity
Organization
Contact information
Practice address
1390 STATE ROUTE 127 S, JONESBORO, IL 62952-2488
(618) 833-5344
(618) 833-8217
Mailing address
1390 STATE ROUTE 127 S, JONESBORO, IL 62952-2488
(618) 833-5344
(618) 833-8217
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0040626
IL
315P00000X
Intellectual Disabilities Intermediate Care Facility
0040970
IL
Other
Enumeration date
02/28/2007
Last updated
08/22/2020
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