NPIMap

Organization Active NPI

Residential Alternatives of Illinois, Inc.

Doing business as Manor Court of Peoria

  • Skilled Nursing Facility
  • Peoria, IL
National Provider Identifier
1700996972
Registry record updated Oct 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0047068 Issued in IL
Legal business name
RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
Doing business as
Manor Court of Peoria
Practice address
6900 N Stalworth Dr
Peoria, IL 61615-9488
Phone
(309) 693-1400
Fax
(309) 683-3561
NPI assigned
Aug 30, 2006
Last updated
Oct 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2008

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

Authorized official

Name
Mr. Ronald J Wilson
Title
Cfo
Phone
(309) 343-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0047068 IL Primary

Addresses

Primary practice location

6900 N Stalworth Dr
Peoria, IL 61615-9488

Mailing address

6906 N Stalworth Dr
Peoria, IL 61615-9488
Phone (309) 693-1400

Other names 1

  • Manor Court of Peoria Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061010000194 IL Part A Provider - Skilled Nursing Facility 0941197354 Practice locations: Peoria, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700996972. Details of each certification follow.

Skilled nursing facility certification: CCN 146108

Legal name
RESIDENTIAL ALTERNATIVES OF ILLINOIS INC
Doing business as
MANOR COURT OF PEORIA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 19, 2006
Last certification
May 16, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Residental Alternatives of Illinois
Organization structure
CorporationNon-profit
Incorporated
Nov 13, 1987 in IL
Enrollment address
6900 N Stalworth Dr
Peoria, IL 61615-9444
Nursing home name
MANOR COURT OF PEORIA
Affiliated entity
RESIDENTIAL ALTERNATIVES OF ILLINOIS

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Manor Court of PeoriaCCN 146108 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 19, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5038.4 residents per day on average
Chain
Residential Alternatives of Illinois7 facilities in the chain
Penalties (3 years)
1Fines totaling $140,847

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Hawthorne Inn Supportive Living Facility11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ronald J Wilson Individual Corporate OfficerChief Financial Officer Aug 20, 2018
William L Kempiners Individual Corporate DirectorBoard Member Aug 30, 2013
Benjamin L McMahan Individual Corporate Director Aug 16, 2018
Terri Edens Individual W-2 Managing EmployeeAdministrator Aug 9, 2018
Douglas O Biederstedt Individual Corporate DirectorBoard Member Aug 30, 2013
Jeffrey W. Shaw Individual Corporate OfficerSecretary of Board of Directors Aug 30, 2013
Corporate DirectorBoard Member Aug 30, 2013
John P Kniery Individual Corporate DirectorBoard Member Aug 30, 2013

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Manor Court of PrincetonPrinceton, IL, CCN 146083 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 3, 2005
Manor Court of PeruPeru, IL, CCN 146091 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 10, 2022
Manor Court of FreeportFreeport, IL, CCN 146102 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2006
Hawthorne Inn of DanvilleDanville, IL, CCN 146090 Skilled nursing facility Operational/Managerial Control (100%) Mar 10, 2022
Windmill ManorCoralville, IA, CCN 165545 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 6, 2022
Manor Court of RochelleRochelle, IL, CCN 146193 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Aug 17, 2020

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1700996972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6906 N STALWORTH DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159488",
            "telephone_number": "309-693-1400",
            "fax_number": "309-683-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 N STALWORTH DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159488",
            "telephone_number": "309-693-1400",
            "fax_number": "309-683-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-343-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0047068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manor Court of Peoria",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.