NPIMap

Organization Active NPI

Rave Residential Services, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Jonesboro, IL
National Provider Identifier
1245423979
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0040626 Issued in IL
Legal business name
RAVE RESIDENTIAL SERVICES, INC.
Practice address
1370 State Route 127 S
Jonesboro, IL 62952-2488
Phone
(618) 833-3235
Fax
(618) 833-3237
NPI assigned
Aug 27, 2007
Organization subpart
Yes
Parent organization
RAVE RESIDENTIAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary L Griffith, L.N.H.A.
Title
Administrator
Phone
(618) 833-5344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0040626 IL Primary

Addresses

Primary practice location

1370 State Route 127 S
Jonesboro, IL 62952-2488

Mailing address

1390 State Route 127 S
Jonesboro, IL 62952-2488
Phone (618) 833-5344

Other names 1

  • Peachtree Estates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Rave Residential Services Inc3 organizations share this tax ID, including this one
Part of
Rave Residential Services Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1245423979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629522488",
            "telephone_number": "618-833-5344",
            "fax_number": "618-833-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629522488",
            "telephone_number": "618-833-3235",
            "fax_number": "618-833-3237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVE RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RAVE RESIDENTIAL SERVICES, INC.",
        "enumeration_date": "2007-08-27",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "GRIFFITH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-833-5344",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.N.H.A."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0040626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peachtree Estates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.