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NPI Code Detail

MEDICARE: COMMUNITY LIVING OPTIONS INC

MEDICARE: COMMUNITY LIVING OPTIONS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility38836IL

General Provider Information

NPI Number : 1447422373
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY LIVING OPTIONS INC
Provider Business Mailing Address
First Line : 285 SOUTH FARNHAM STREET
Second Line :
City : GALESBURG
State : IL
Zip : 61401-5323
Country : US
Telephone Number : 309-343-1550
Fax Number : 309-343-6318
Provider Business Practice Location Address
First Line : 408 ANNA STREET
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-2847
Country : US
Telephone Number : 217-245-5566
Fax Number : 217-245-5461
Authorized Official
Title or Position : AUTHORIZED AGENT
Name : MR. RONALD J WILSON
Credential :
Telephone Number : 309-343-1550
Provider Enumeration Date : 04/01/2008
Last Update Date : 04/20/2008

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Directions to “COMMUNITY LIVING OPTIONS INC ” Practice Location

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