COMMUNITY RESIDENTIAL CENTERS INC (NPI# 1114140373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114140373 |
| Entity Type | Organization |
| Organization Name | COMMUNITY RESIDENTIAL CENTERS INC |
| Other Organization Name | ST MARYS SQUARE LIVING CENTER |
| Practice Address |
239 S Cherry Street Galesburg IL 61401 |
| Practice Telephone | 3093434101 |
| Practice Fax Number | 3093434106 |
| Mailing Telephone | 3093434101 |
| Mailing Fax Number | 3093434106 |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. BOBBY D DILLARD (ADMINISTRATOR) |
| Authorized Official Telephone | 3093434101 |
| Authorized Official Credential | MS LNHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 003406 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| St Marys Square Living Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043482979 | Community Residential Centers Inc | Intermediate Care Facility, Mentally Retarded | 239 South Cherry Street, Galesburg, IL 61401-4911 | 2008-04-01 |
| Street Address |
239 S CHERRY STREET |
| City | GALESBURG |
| State | IL |
| Zip Code | 61401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174973 | Jeff Engwall | Pharmacist | 359 Knox Square Drive, Galesburg, IL 61401 | 2020-11-03 |
| 1861962441 | Becky Cameron | Counselor | 2323 Windish Dr., Galesburg, IL 61401 | 2018-11-27 |
| 1295245496 | Aaron Thomas Wachtel | Dentist | 1172 Monroe Street, Galesburg, IL 61401 | 2017-10-03 |
| 1588182224 | Alicia Warren | Speech-Language Pathologist | 932 Harrison St., Galesburg, IL 61401 | 2017-09-01 |
| 1770986770 | Virginia G Kasser | Psychologist | 575 N Kellogg, Galesburg, IL 61401 | 2014-10-03 |
| 1063814309 | Lakshmi Kalyani Gudavalli | Physical Therapist | 275 E Carl Sandburg Drive, Marigold Rehabilitation, Galesburg, IL 61401 | 2014-09-18 |
| 1821350489 | James Eugene Tiller | Psychologist | 2101 Windish Drive, Galesburg, IL 61401 | 2012-06-11 |
| 1720285836 | Donald J. Regnier | Hearing Instrument Specialist | 4l Plaza, Suite 57, Galesburg, IL 61401 | 2007-07-02 |
| 1306066535 | Arnold John Minor | Dentist | 69 N Chambers St, Galesburg, IL 61401 | 2007-04-30 |
| 1508939794 | Mohammad Sami | Psychiatry & Neurology | 2323 Windish Drive, Bridgeway Inc, Galesburg, IL 61401 | 2006-11-16 |
| Find all providers in zip 61401 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720250640 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2016 Windish Drive, Galesburg, IL 61401-9773 | 2008-04-01 |
| 1811169741 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2182 Windish Drive, Galesburg, IL 61401-9775 | 2008-04-01 |
| 1902078835 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 356 S Michigan Ave, Galesburg, IL 61401-5443 | 2008-04-01 |
| 1538331467 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 260 S Michigan Drive, Galesburg, IL 61401-5441 | 2008-04-01 |
| 1043482979 | Community Residential Centers Inc | Intermediate Care Facility, Mentally Retarded | 239 South Cherry Street, Galesburg, IL 61401-4911 | 2008-04-01 |
| 1942472071 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 184 Maple Street, Galesburg, IL 61401-3555 | 2008-03-28 |
| 1629240064 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2136 Windish Drive, Galesburg, IL 61401-9775 | 2008-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871039669 | Mount St Joseph | Intermediate Care Facility, Mentally Retarded | 24955 N Us Highway 12, Lake Zurich, IL 60047-8919 | 2017-01-17 |
| 1447792221 | Shore Community Services, Inc. | Intermediate Care Facility, Mentally Retarded | 8350 Laramie Ave, Skokie, IL 60077-2461 | 2016-11-10 |
| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
| 1265898266 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 102 S Douglas St, Mc Leansboro, IL 62859-1637 | 2016-01-06 |
| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1376909374 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 416 Chula Vista Dr, Belleville, IL 62221-3160 | 2016-01-06 |
| 1437515434 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 206 N Washington St, Mc Leansboro, IL 62859-1049 | 2016-01-06 |
| 1790141885 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 212 Turning Leaf Cir, Belleville, IL 62221-6747 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.