Healthcare Provider Details

I. General information

NPI: 1285860452
Provider Name (Legal Business Name): RESIDENTIAL OPTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 RIDGEWOOD CT
COLLINSVILLE IL
62234-4146
US

IV. Provider business mailing address

4 EMMIE L KAUS LN
ALTON IL
62002-8865
US

V. Phone/Fax

Practice location:
  • Phone: 618-346-1360
  • Fax: 618-346-1363
Mailing address:
  • Phone: 618-465-0044
  • Fax: 618-462-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number94S229
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number94S229
License Number StateIL

VIII. Authorized Official

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