NPIMap

Organization Active NPI

Rave Residential Services, Inc

Doing business as Orchard Court

  • Intellectual Disabilities Intermediate Care Facility
  • Jonesboro, IL
National Provider Identifier
1609069335
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0040970 Issued in IL
Legal business name
RAVE RESIDENTIAL SERVICES, INC
Doing business as
Orchard Court
Practice address
1430 State Route 127 S
Jonesboro, IL 62952-2489
Phone
(618) 833-8033
Fax
(618) 833-8035
NPI assigned
Aug 27, 2007
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

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 0040970 IL Primary

Addresses

Primary practice location

1430 State Route 127 S
Jonesboro, IL 62952-2489

Mailing address

1390 State Route 127 S
Jonesboro, IL 62952-2488
Phone (618) 833-5377

Other names 1

  • Orchard Court Doing business as

National Provider Directory

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

Other organizations with this tax ID 2

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

Locations

1430 State Route 127 S
Jonesboro, IL 62952
Phone (618) 833-8033

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": "1609069335",
    "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": "618-833-5377",
            "fax_number": "618-833-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629522489",
            "telephone_number": "618-833-8033",
            "fax_number": "618-833-8035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVE RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "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": "0040970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orchard Court",
            "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.