Organization · Type 2 NPI

Community Living Options Inc

Intellectual Disabilities Intermediate Care Facility · Jacksonville, IL

NPI number 1568634699 Active

Practice location

2 Eisenhower Drive
Jacksonville, IL 62650-1735

Call (217) 245-0055 Map

Fax (217) 245-9385

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	40279 (IL)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

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NPI record

NPI: 1568634699
Entity type: Organization (Type 2)
Issued: Mar 28, 2008
Last updated: Apr 20, 2008
Status: Active
Subpart: Yes of Community Living Options Inc

Other names

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Eisenhower Terrace · doing business as

Authorized official

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

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1568634699

Community Living Options Inc's National Provider Identifier is 1568634699, issued on Mar 28, 2008. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Jacksonville, IL. The record was last updated on Apr 20, 2008.