NPIMap

Organization Active NPI

Community Living Options Inc

Doing business as Glenwood Terrace

  • Intellectual Disabilities Intermediate Care Facility
  • Springfield, IL
National Provider Identifier
1356513790
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
35063 Issued in IL
Legal business name
COMMUNITY LIVING OPTIONS INC
Doing business as
Glenwood Terrace
Practice address
2724 Glenwood Ave
Springfield, IL 62704-5010
Phone
(217) 523-0182
Fax
(217) 523-4605
NPI assigned
Mar 26, 2008
Last updated
Apr 20, 2008By the provider in NPPES
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 35063 IL Primary

Addresses

Primary practice location

2724 Glenwood Ave
Springfield, IL 62704-5010

Mailing address

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

Other names 1

  • Glenwood Terrace Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356513790. Details of each certification follow.

  • CCN 14G193 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G193

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
GLENWOOD TERRACE-SPRINGFIELD
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Sep 6, 1988
Last certification
Jul 22, 2024
Beds
16
Ownership / control type
Private (non-profit)
Facility address
2724 Glenwood Avenue
Springfield, IL 62704

National Provider Directory

National Provider Directory
Tax ID family
Community Living Options40 organizations share this tax ID, including this one
Part of
Community Living Options

Other organizations with this tax ID 39

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

View all 39

Locations

2724 S Glenwood Ave
Springfield, IL 62704
Phone (217) 481-0981

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": "1206489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1356513790",
    "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": "2724 GLENWOOD AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627045010",
            "telephone_number": "217-523-0182",
            "fax_number": "217-523-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIVING OPTIONS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY LIVING OPTIONS INC",
        "enumeration_date": "2008-03-26",
        "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": "35063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.