Organization
COMMUNITY RESIDENTIAL CENTERS INC
Active
Other names
St Marys Square Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY D DILLARD MS LNHA (ADMINISTRATOR)
(309) 343-4101
Entity
Organization
Contact information
Practice address
239 S CHERRY STREET, GALESBURG, IL 61401
(309) 343-4101
(309) 343-4106
Mailing address
239 S CHERRY STREET, GALESBURG, IL 61401
(309) 343-4101
(309) 343-4106
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
003406
IL
Other
Enumeration date
04/10/2007
Last updated
08/22/2020
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