Organization
RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC
Active
Other names
Coralville Manor LLC , Windmill Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD J WILSON (CHIEF FINANCIAL OFFICER)
(309) 343-1550
Entity
Organization
Contact information
Practice address
2332 LIBERTY DR, CORALVILLE, IA 52241-2771
(319) 545-7390
(319) 545-7393
Mailing address
2332 LIBERTY DR, CORALVILLE, IA 52241-2771
(319) 545-7390
(319) 545-7393
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
165545
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0809673
—
IA
01
—
65545
BLUE CROSS BLUE SHEILD #
IA
Enumeration date
10/11/2005
Last updated
07/18/2016
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