COMMUNITY LIVING OPTIONS INC NPI 1750553103

NPI Information

  • NPI: 1750553103
  • Provider Name: COMMUNITY LIVING OPTIONS INC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: DAVIES SQUARE
  • CLIA Number: 14D0892820
  • Address: 1817 CRESCENT DRIVE
    PEKIN, IL
    ZIP 61554
  • Phone: (309) 347-6803

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NPI Details

COMMUNITY LIVING OPTIONS INC is an intermediate care facility mentally retarded in Pekin, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. COMMUNITY LIVING OPTIONS INC NPI is 1750553103. The provider is registered as an organization entity type.
The provider Is Doing Business As Davies Square.

The provider's business location address is:

1817 CRESCENT DRIVE
PEKIN, IL
ZIP 61554-572
Phone: (309) 347-6803
Fax: (309) 347-5796

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 CLIA number assigned to this NPI record is 14D0892820 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/26/2008 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
1315P00000XIntermediate Care Facility, Intellectual Disabilities31955ILLINOISYes

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=========016MEDICAIDILLINOIS

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: 11/21/2025

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