NPIMap

Organization Active NPI

Community Living Options Inc

Doing business as Campbell Court

  • Intellectual Disabilities Intermediate Care Facility
  • Jacksonville, IL
National Provider Identifier
1366614281
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
38851 Issued in IL
Legal business name
COMMUNITY LIVING OPTIONS INC
Doing business as
Campbell Court
Practice address
426 E Douglas
Jacksonville, IL 62650-2114
Phone
(217) 245-8001
Fax
(217) 245-4533
NPI assigned
Apr 1, 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 38851 IL Primary

Addresses

Primary practice location

426 E Douglas
Jacksonville, IL 62650-2114

Mailing address

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

Other names 1

  • Campbell Court 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 1366614281. Details of each certification follow.

  • CCN 14G315 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 14G315

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
CAMPBELL COURT
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 27, 1993
Last certification
Jan 8, 2025
Beds
4
Ownership / control type
Private (non-profit)
Most recent change of ownership
Aug 1, 2018
Facility address
426 E. Douglas
Jacksonville, IL 62650

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

426 E Douglas Ave
Jacksonville, IL 62650
Phone (217) 245-8001

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": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1366614281",
    "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": "426 E DOUGLAS",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502114",
            "telephone_number": "217-245-8001",
            "fax_number": "217-245-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIVING OPTIONS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY LIVING OPTIONS INC",
        "enumeration_date": "2008-04-01",
        "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": "38851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell Court",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

Sources for this page

Verify at the official NPI Registry.