Organization Name: | R&J ENTERPRISES COUNTRY LIVING, INC |
NPI Number: | 1508231879 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY CATES (ACTING DIRECTOR) |
Mailing Address: | 221 East Ave Anna |
State: | IL US |
Postal Code: | 629061903 |
Phone Number: | 6188337418 |
Fax Number: | 6188335400 |
NPI Enumeration Date: | 12/11/2015 |
NPI Last Update Date: | 12/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 199400203S |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |