COMMUNITY LIVING OPTIONS INC (NPI# 1548432461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548432461 |
| Entity Type | Organization |
| Organization Name | COMMUNITY LIVING OPTIONS INC |
| Other Organization Name | THELMA TERRACE |
| Practice Address |
1450 Virginia Avenue Wood River IL 62095-1808 |
| Mailing Address |
285 South Farnham Street Galesburg IL 61401-5323 |
| Practice Telephone | 6182592777 |
| Practice Fax Number | 6182590781 |
| Mailing Telephone | 3093431550 |
| Mailing Fax Number | 3093436318 |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. RONALD J WILSON (AUTHORIZED AGENT) |
| Authorized Official Telephone | 3093431550 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY LIVING OPTIONS INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 34025 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Thelma Terrace | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639341563 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 321 Chestnut, Paris, IL 61944-1407 | 2008-04-01 |
| 1366614281 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 426 E Douglas, Jacksonville, IL 62650-2114 | 2008-04-01 |
| 1457523383 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2883 Taylor Ave, Springfield, IL 62703-4323 | 2008-04-01 |
| 1447422373 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 408 Anna Street, Jacksonville, IL 62650-2847 | 2008-04-01 |
| 1720250640 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2016 Windish Drive, Galesburg, IL 61401-9773 | 2008-04-01 |
| 1811169741 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 2182 Windish Drive, Galesburg, IL 61401-9775 | 2008-04-01 |
| 1902078835 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 356 S Michigan Ave, Galesburg, IL 61401-5443 | 2008-04-01 |
| 1710159645 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 1101 S Third Street, Effingham, IL 62401-4022 | 2008-04-01 |
| 1538331467 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 260 S Michigan Drive, Galesburg, IL 61401-5441 | 2008-04-01 |
| 1295907327 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 95 N Main, Wood River, IL 62095-1415 | 2008-03-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMUNITY LIVING OPTIONS INC | 285 S Farnham St, Galesburg, IL 61401-5323 |
| Street Address |
1450 VIRGINIA AVENUE |
| City | WOOD RIVER |
| State | IL |
| Zip Code | 62095-1808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467698068 | Jkh Management, LLC | Clinic/Center | 1138 Vaughn Road, Wood River, IL 62095 | 2009-01-02 |
| 1972762367 | Ronald Weems Jr P.C. | Dentist | 1915 Vaughn Road, Wood River, IL 62095 | 2008-06-02 |
| 1306010913 | Kristin Nicole Kellim | Specialist | 1138 Vaughn Rd, Wood River, IL 62095 | 2008-04-15 |
| 1124240569 | Denise Marie Jacquin | Optometrist | 650 Wesley Drive, Wood River Centre, Wood River, IL 62095 | 2007-05-03 |
| 1982734414 | Kathleen Crockett | Physical Therapist | 400 S Main, Wood River, IL 62095 | 2007-03-06 |
| 1336200286 | Johan C Dinkelmann | Chiropractor | 21 E Acton Ave, Wood River, IL 62095 | 2006-12-13 |
| 1760418099 | Hagopian Shoes, LLC | Prosthetic/Orthotic Supplier | 48 E Ferguson Ave, Wood River, IL 62095 | 2006-06-26 |
| 1063470524 | Jerseyville Pain Management Center, S.c. | Chiropractor | 1702 Vaughn Rd, Wood River, IL 62095 | 2006-05-03 |
| 1831354257 | Benjamin Hite | Dentist | 1915 Vaughn Road, Wood River, IL 62095 | 2008-07-24 |
| 1679797294 | Rhonda Nemsky | Developmental Therapist | 400 S Main, Wood River, IL 62095 | 2007-04-13 |
| Find all providers in zip 62095 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295907327 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 95 N Main, Wood River, IL 62095-1415 | 2008-03-28 |
| 1922270057 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 330 Linton Avenue, Wood River, IL 62095-3257 | 2008-03-28 |
| 1164694501 | Community Living Options Inc | Intermediate Care Facility, Mentally Retarded | 460 Pershing, Wood River, IL 62095-1316 | 2008-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871039669 | Mount St Joseph | Intermediate Care Facility, Mentally Retarded | 24955 N Us Highway 12, Lake Zurich, IL 60047-8919 | 2017-01-17 |
| 1447792221 | Shore Community Services, Inc. | Intermediate Care Facility, Mentally Retarded | 8350 Laramie Ave, Skokie, IL 60077-2461 | 2016-11-10 |
| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
| 1265898266 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 102 S Douglas St, Mc Leansboro, IL 62859-1637 | 2016-01-06 |
| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1376909374 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 416 Chula Vista Dr, Belleville, IL 62221-3160 | 2016-01-06 |
| 1437515434 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 206 N Washington St, Mc Leansboro, IL 62859-1049 | 2016-01-06 |
| 1790141885 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 212 Turning Leaf Cir, Belleville, IL 62221-6747 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
| Find all providers with the same taxonomy | ||||
| City | WOOD RIVER |
| Zip Code | 62095 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.