Healthcare Provider Details

I. General information

NPI: 1275801037
Provider Name (Legal Business Name): RESIDENTIAL OPTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 OAKWOOD AVE
ALTON IL
62002-5278
US

IV. Provider business mailing address

4 EMMIE L KAUS LN
ALTON IL
62002-8865
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-0751
  • Fax: 618-463-1678
Mailing address:
  • Phone: 618-465-0044
  • Fax: 618-462-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANE TEBBE
Title or Position: VICE PRESIDENT
Credential:
Phone: 618-465-0044