Rave Residential Services, Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

0040626 Issued in IL

Legal business name

RAVE RESIDENTIAL SERVICES, INC

Practice address

1390 State Route 127 S
Jonesboro, IL 62952-2488

Phone

(618) 833-5344

Fax

(618) 833-8217

NPI assigned

Feb 28, 2007

Organization subpart

No

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 2

Addresses

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.

• Rave Residential Services, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Jonesboro, IL
  • NPI 1609069335
  NPD tax ID
• Rave Residential Services, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Jonesboro, IL
  • NPI 1245423979
  NPD tax ID

Locations

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720116262",
    "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": "618-833-5344",
            "fax_number": "618-833-8217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 STATE ROUTE 127 S",
            "city": "JONESBORO",
            "state": "IL",
            "postal_code": "629522488",
            "telephone_number": "618-833-5344",
            "fax_number": "618-833-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAVE RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "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": "0040626",
            "primary": true
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0040970",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Ann Palmer, MS,SLP
• Petersen Health Operations, LLC
• Petersen Health Properties, LLC
• Lori Randolph, LCSW, PEL, CYT 200
• Rave Residential Services, Inc
• Rave Residential Services, Inc.
• Maria Patricia Salazar
• Cassie N York

• Intellectual Disabilities Intermediate Care Facility in Jonesboro, IL
• Providers in Jonesboro, 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 Aug 22, 2020; 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.