Sullivan House Residential Care, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0034140 Issued in IL

Legal business name

SULLIVAN HOUSE RESIDENTIAL CARE, INC.

Practice address

600 Grover Ave
Ottawa, IL 61350-4140

Phone

(815) 433-5858

Fax

(815) 673-3231

NPI assigned

Feb 6, 2008

Organization subpart

No

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

Authorized official

Name

Ralph S Gomes

Title

President

Phone

(815) 433-5858

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1487832903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 GROVER AVE",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613504140",
            "telephone_number": "815-433-5858",
            "fax_number": "815-673-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GROVER AVE",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613504140",
            "telephone_number": "815-433-5858",
            "fax_number": "815-673-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN HOUSE RESIDENTIAL CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "GOMES",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-433-5858"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0034140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sshe RFMF Inc
• St. Mary'S Hospital
• Lisa Stanek, APRN
• Starved Rock Regional Center for Therapy & Child Development
• Matthew B Steele, PTA
• Susan Koestler LCSW, Inc.
• Jennifer L Swanson, OTRL
• Taylor V Swanson, PT, DPT
• Chin W Swong, MD
• Synergy Institute S.C.

• Intellectual Disabilities Intermediate Care Facility in Ottawa, IL
• Providers in Ottawa, IL by specialty
• Intellectual Disabilities Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.