COMMUNITY RESIDENTIAL CENTERS INC NPI 1114140373

NPI Information

  • NPI: 1114140373
  • 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 S 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 1114140373. 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 S CHERRY STREET
GALESBURG, IL
ZIP 61401
Phone: (309) 343-4101
Fax: (309) 343-4106

The provider's authorized official is Bobby D Dillard .
The authorized official title is Administrator and has the following contact phone number (309) 343-4101.

The enumeration date for this NPI number is 4/10/2007 and was last updated on 8/22/2020.

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 Disabilities003406ILLINOISYes

What is NPI?

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

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