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Organization Active NPI

Community Living Options Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Edwardsville, IL
National Provider Identifier
1932371382
Registry record updated Apr 20, 2008
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Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
38844 Issued in IL
Legal business name
COMMUNITY LIVING OPTIONS INC
Practice address
808 Southwest Place
Edwardsville, IL 62025-3661
Phone
(618) 656-6161
Fax
(618) 656-6286
NPI assigned
Mar 26, 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 38844 IL Primary

Addresses

Primary practice location

808 Southwest Place
Edwardsville, IL 62025-3661

Mailing address

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

Other names 1

  • Edwardsville 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 14G312

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
EDWARDSVILLE TERRACE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Nov 26, 1993
Last certification
Nov 22, 2024
Beds
16
Ownership / control type
Private (non-profit)
Most recent change of ownership
Oct 24, 2006
Facility address
808 Southwest Place
Edwardsville, IL 62025

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

Locations

808 Southwest Pl
Edwardsville, IL 62025
Phone (618) 656-6161

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": "1932371382",
    "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": "808 SOUTHWEST PLACE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253661",
            "telephone_number": "618-656-6161",
            "fax_number": "618-656-6286"
        }
    ],
    "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": "38844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edwardsville Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edwardsville, IL

Sources for this page

Verify at the official NPI Registry.