ST MARYS SQUARE LIVING CENTER
NPI 1114140373
Intermediate Care Facility, Intellectual Disabilities in Galesburg, IL
- Organization
- Intermediate Care Facility, Intellectual...
About ST MARYS SQUARE LIVING CENTER
This page provides the complete NPI Profile along with additional information for St Marys Square Living Center, a provider established in Galesburg, Illinois operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1114140373 assigned on April 2007. The practitioner's primary taxonomy code is 315P00000X with license number 003406 (IL). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as St Marys Square Living Center. The authorized official of this NPI record is Mr. Bobby D Dillard Ms Lnha (Administrator)
- NPI
- 1114140373 Verify this NPI
- Provider Legal Name
- COMMUNITY RESIDENTIAL CENTERS INC
- Other Organization Name
- ST MARYS SQUARE LIVING CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 239 S CHERRY STREET GALESBURG, IL 61401
- Location Phone
- (309) 343-4101
- Location Fax
- (309) 343-4106
- Mailing Address
- 239 S CHERRY STREET GALESBURG, IL 61401
- Mailing Phone
- (309) 343-4101
- Mailing Fax
- (309) 343-4106
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-10-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Intermediate Care Facility, Intellectual Disabilities
- Taxonomy Code
- 315P00000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 003406
- License State
- IL
- Taxonomy Description
- An intermediate care facility providing services for individuals with intellectual disabilities.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1114140373, enumerated as an "organization" on April 10, 2007.
The provider is located at 239 S CHERRY STREET GALESBURG, IL 61401 and the phone number is (309) 343-4101.
Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
