NPIMap

Organization Active NPI

Pioneer Concepts Inc

Doing business as Ravisloe Terrace

  • Intellectual Disabilities Intermediate Care Facility
  • Country Club Hills, IL
National Provider Identifier
1801069430
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
43307 Issued in IL
Legal business name
PIONEER CONCEPTS INC
Doing business as
Ravisloe Terrace
Practice address
18227 Ravisloe
Country Club Hills, IL 60478-5357
Phone
(708) 922-1240
Fax
(708) 922-1196
NPI assigned
Apr 3, 2008
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PIONEER CONCETPS INCAs reported in NPPES

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. Ronald J Wilson
Title
Authorized Agent
Phone
(309) 343-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 43307 IL Primary

Addresses

Primary practice location

18227 Ravisloe
Country Club Hills, IL 60478-5357

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323
Phone (309) 343-1550

Other names 1

  • Ravisloe Terrace Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801069430. Details of each certification follow.

  • CCN 14G328 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G328

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
RAVISLOE TERRACE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 3, 1994
Last certification
Jan 30, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
18227 Ravisloe
Country Club Hills, IL 60478

National Provider Directory

National Provider Directory
Tax ID family
Pioneer Concepts Inc13 organizations share this tax ID, including this one
Part of
Pioneer Concepts Inc

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1801069430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 SOUTH FARNHAM STREET",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614015323",
            "telephone_number": "309-343-1550",
            "fax_number": "309-343-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18227 RAVISLOE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604785357",
            "telephone_number": "708-922-1240",
            "fax_number": "708-922-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER CONCEPTS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PIONEER CONCETPS INC",
        "enumeration_date": "2008-04-03",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "309-343-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "43307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ravisloe Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Country Club Hills, IL

Sources for this page

Verify at the official NPI Registry.