Basic Information
| Provider Information | |||||||||
| NPI: | 1700061538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RES-CARE PREMIER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 LINN STATION RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008660860 | ||||||||
| FaxNumber: | 5023942285 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 ROBEY AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605163445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309699188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2007 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | OMBRES | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOC. GEN. COUNSEL/PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5023942387 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | IL | N | Agencies | Home Health | 251C00000X | IL | N | Agencies | Day Training, Developmentally Disabled Services | 251S00000X | 4000027 | IL | N | Agencies | Community/Behavioral Health | 320700000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 318603725 | 05 | IL | MEDICAID |