Organization · Type 2 NPI

Community Living Options Inc

Intellectual Disabilities Intermediate Care Facility · Edwardsville, IL

NPI number 1932371382 Active

Practice location

808 Southwest Place
Edwardsville, IL 62025-3661

Call (618) 656-6161 Map

Fax (618) 656-6286

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	38844 (IL)

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

NPI record

NPI: 1932371382
Entity type: Organization (Type 2)
Issued: Mar 26, 2008
Last updated: Apr 20, 2008
Status: Active
Subpart: Yes of Community Living Options Inc

Other names

<unavail>
Edwardsville 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 1932371382

Community Living Options Inc's National Provider Identifier is 1932371382, issued on Mar 26, 2008. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Edwardsville, IL. The record was last updated on Apr 20, 2008.