COMMUNITY RESIDENTIAL CENTERS INC NPI 1043482979

NPI Information

  • NPI: 1043482979
  • Provider Name: COMMUNITY RESIDENTIAL CENTERS INC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: ST MARYS SQUARE LIVING CENTER
  • Address: 239 SOUTH CHERRY STREET
    GALESBURG, IL
    ZIP 61401
  • Phone: (309) 343-4101

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NPI Details

COMMUNITY RESIDENTIAL CENTERS INC is an intermediate care facility mentally retarded in Galesburg, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. COMMUNITY RESIDENTIAL CENTERS INC NPI is 1043482979. The provider is registered as an organization entity type.
The provider Is Doing Business As St Marys Square Living Center.

The provider's business location address is:

239 SOUTH CHERRY STREET
GALESBURG, IL
ZIP 61401-911
Phone: (309) 343-4101
Fax: (309) 343-4118

The provider's authorized official is Ronald J Wilson .
The authorized official title is Authorized Agent and has the following contact phone number (309) 343-1550.

The enumeration date for this NPI number is 4/1/2008 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Intellectual Disabilities34066ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========001MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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