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Organization Active NPI

Community Living Options Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Wood River, IL
National Provider Identifier
1295907327
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
39099 Issued in IL
Legal business name
COMMUNITY LIVING OPTIONS INC
Practice address
95 N Main
Wood River, IL 62095-1415
Phone
(618) 254-4400
Fax
(618) 254-6620
NPI assigned
Mar 28, 2008
Organization subpart
Yes
Parent organization
COMMUNITY LIVING OPTIONS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 39099 IL Primary

Addresses

Primary practice location

95 N Main
Wood River, IL 62095-1415

Mailing address

285 South Farnham Street
Galesburg, IL 61401-5323
Phone (309) 343-1550

Other names 1

  • Madison Terrace Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G333

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MADISON TERRACE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 31, 1994
Last certification
Jun 2, 2025
Beds
4
Ownership / control type
Private (non-profit)
Facility address
95 North Main
Wood River, IL 62095

National Provider Directory

National Provider Directory
Tax ID family
Community Living Options Inc40 organizations share this tax ID, including this one
Part of
Community Living Options Inc

Other organizations with this tax ID 39

Organizations that report the same tax identification number in the National Provider Directory.

View all 39

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1295907327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 SOUTH FARNHAM STREET",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614015323",
            "telephone_number": "309-343-1550",
            "fax_number": "309-343-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 N MAIN",
            "city": "WOOD RIVER",
            "state": "IL",
            "postal_code": "620951415",
            "telephone_number": "618-254-4400",
            "fax_number": "618-254-6620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIVING OPTIONS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY LIVING OPTIONS INC",
        "enumeration_date": "2008-03-28",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "309-343-1550",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "39099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wood River, IL

Sources for this page

Verify at the official NPI Registry.