Organization
COMMUNITY RESIDENTIAL CENTERS INC
Active
Parent organization
COMMUNITY RESIDENTIAL CENTERS INC
Other names
St Marys Square Living Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY RESIDENTIAL CENTERS INC
Authorized official
MR. RONALD J WILSON (AUTHORIZED AGENT)
(309) 343-1550
Entity
Organization
Contact information
Practice address
239 SOUTH CHERRY STREET, GALESBURG, IL 61401-4911
(309) 343-4101
(309) 343-4118
Mailing address
285 SOUTH FARNHAM STREET, GALESBURG, IL 61401-5323
(309) 343-1550
(309) 343-6318
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
34066
IL
Other
Enumeration date
04/01/2008
Last updated
04/20/2008
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