Residential Alternatives of Illinois, Inc.
Organization Active NPI Skilled Nursing Facility · Peoria, IL
NPI 1700996972 · NPPES record last updated Oct 7, 2008
Key facts
- NPI
- 1700996972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 0047068 (IL)
- Legal business name
- RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC.
- Practice address
- 6900 N Stalworth Dr
Peoria, IL 61615-9488 - Phone
- (309) 693-1400
- Fax
- (309) 683-3561
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Ronald J Wilson
- Title
- Cfo
- Phone
- (309) 343-1550
Owned or controlled facilities with NPI records 6
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 10
Affiliated clinicians 1
-
Jay S Harms, MD
Medicare Care Compare: Nursing home
- Listed as
- Manor Court of Peoria
- 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
- Active
- Certified beds
- 50 · 38.4 residents per day on average
- Chain
- Residential Alternatives of Illinois
- Penalties (3 years)
- 1 · fines totaling $140,847
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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
- Corporation · Non-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
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Ronald J Wilson |
Corporate Officer |
Aug 20, 2018 | |
| William L Kempiners |
Corporate Director |
Aug 30, 2013 | |
| Benjamin L McMahan |
Corporate Director | Aug 16, 2018 | |
| Terri Edens |
W-2 Managing Employee |
Aug 9, 2018 | |
| Douglas O Biederstedt |
Corporate Director |
Aug 30, 2013 | |
| Jeffrey W. Shaw |
Corporate Officer |
Aug 30, 2013 | |
| Corporate Director |
Aug 30, 2013 | ||
| John P Kniery |
Corporate Director |
Aug 30, 2013 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Manor Court of Princeton |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 3, 2005 |
| Manor Court of Peru |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Mar 10, 2022 |
| Manor Court of Freeport |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 9, 2006 |
| Hawthorne Inn of Danville |
Skilled nursing facility | Operational/Managerial Control (100%) | Mar 10, 2022 |
| Windmill Manor |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Apr 6, 2022 |
| Manor Court of Rochelle |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Aug 17, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061010000194 | IL | Part a Provider - Skilled Nursing Facility | 0941197354 | Practice locations: Peoria, IL |
National Provider Directory
- Tax ID family
- Residential Alternatives of Illinois Inc
Locations
6900 N Stalworth Dr
Peoria, IL 61615
Phone (309) 243-1167
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 0047068 | IL | Yes |
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
- Manor Court of Peoria
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- Olivia Renken
- Amanda Repplinger
- Carlos Andres Requena Armas
- Alyssa Rescinito
- Jacob Alexander Reshetar
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- Respiratory Unit Dose Pharmacy Inc.
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- Courtney Elizabeth Reubin
All providers in Peoria, IL · Skilled Nursing Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.