Southeastern Residential Alternatives, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SOUTHEASTERN RESIDENTIAL ALTERNATIVES, INC.

Practice address

125 W Clark St
Harrisburg, IL 62946-2738

Phone

(618) 272-5007

Fax

(618) 272-3091

NPI assigned

Dec 17, 2015

Organization subpart

No

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

Authorized official

Name

Grant Cape

Title

President of the Board

Phone

(618) 272-5007

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1265897201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 465",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629460465",
            "telephone_number": "618-272-5007",
            "fax_number": "618-272-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W CLARK ST",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462738",
            "telephone_number": "618-272-5007",
            "fax_number": "618-272-3091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RESIDENTIAL ALTERNATIVES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "CAPE",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "PRESIDENT OF THE BOARD",
        "authorized_official_telephone_number": "618-272-5007"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charli Walter Leroy Smith Jr., M.D.
• Kimberly Dawn Smith
• Mary Darlene Smith
• Patricia Smith, MD
• Pennie Lowanda Smith, PA
• Southern Illinois Hospital Services
• Southern Illinois Hospital Services
• Southern Illinois Hospital Services
• Southern Illinois Medical Services, NFP
• Southern Illinois Surgical Appliance Co

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Harrisburg, IL
• Providers in Harrisburg, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; 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.