COMMUNITY LIVING OPTIONS INC NPI 1295907327

NPI Information

NPI: 1295907327
Provider Name: COMMUNITY LIVING OPTIONS INC

Doing Business As: MADISON TERRACE

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
95 N MAIN
WOOD RIVER, IL
ZIP 62095
Phone: (618) 254-4400
Get Directions

COMMUNITY LIVING OPTIONS INC is an intermediate care facility mentally retarded in Wood River, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. COMMUNITY LIVING OPTIONS INC NPI is 1295907327. The provider is registered as an organization entity type.
The provider Is Doing Business As Madison Terrace.

The provider's business location address is:

95 N MAIN
WOOD RIVER, IL
ZIP 62095-415
Phone: (618) 254-4400
Fax: (618) 254-6620

The provider's authorized official is Ronald J Wilson .
The authorized official title is Authorized Agent and has the following contact phone number (309) 343-1550.

The enumeration date for this NPI number is 3/28/2008 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		39099	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========054	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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