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ST MARYS SQUARE LIVING CENTER
NPI 1043482979
Intermediate Care Facility, Intellectual Disabilities in Galesburg, IL

Active since April 01, 2008
239 SOUTH CHERRY STREET, GALESBURG, IL 61401(309) 343-4101(309) 343-4118 Get Directions Write a Review

NPPES record last updated: April 20, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About St Marys Square Living Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST MARYS SQUARE LIVING CENTER (NPI 1043482979) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Galesburg, Illinois and active in the NPI registry since April 2008. The organization lists Ronald J Wilson, Authorized Agent, as its authorized official.

NPPES Registry Identity

NPI1043482979
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameCOMMUNITY RESIDENTIAL CENTERS INC
Location Address239 SOUTH CHERRY STREETGalesburg, IL 61401-4911
Mailing Address285 South Farnham StreetGalesburg, IL 61401-5323 · (309) 343-1550 · Fax (309) 343-6318
Phone(309) 343-4101
Fax(309) 343-4118
Organization SubpartYes
Authorized OfficialRonald J WilsonAuthorized Agent · (309) 343-1550
Enumeration DateApril 1, 2008
Last NPPES UpdateApril 20, 2008
✔ NPI 1043482979 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in IL · 34066
Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

239 SOUTH CHERRY STREET, Galesburg, IL 61401
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Other Names 1

Doing Business AsSt Marys Square Living Center

Other Identifiers 1

Medicaid=========001IL

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Community Residential Centers Inc's NPI number?

The NPI number for Community Residential Centers Inc is 1043482979. It was assigned to this organization in the NPPES registry on April 1, 2008. The provider is doing business as St Marys Square Living Center.

Where is Community Residential Centers Inc located?

Community Residential Centers Inc is located at 239 South Cherry Street, Galesburg, IL 61401. The listed phone number is (309) 343-4101.

What is Community Residential Centers Inc's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Community Residential Centers Inc was last updated on April 20, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.