Provider Demographics
NPI:1194721969
Name:COMMUNITY RETIREMENT, INC.
Entity type:Organization
Organization Name:COMMUNITY RETIREMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-543-2938
Mailing Address - Street 1:423 S EBERHARDT DR
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911-1224
Mailing Address - Country:US
Mailing Address - Phone:217-543-2103
Mailing Address - Fax:217-543-2278
Practice Address - Street 1:423 S EBERHARDT DR
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1224
Practice Address - Country:US
Practice Address - Phone:217-543-2103
Practice Address - Fax:217-543-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005462314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0005462OtherLICENSE-IL PUBLIC HEALTH
IL=========001Medicaid
IL146023Medicare Oscar/Certification