MEDICARE: RESIDENTIAL 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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	0036210	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6012546	OTHER	IL	PUBLIC HEALTH FACILITY ID

General Provider Information

NPI Number	:	1952522922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL OPTIONS, INC.

Provider Business Mailing Address
First Line	:	1108 ENGINEER RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-2890
Country	:	US
Telephone Number	:	618-797-2320
Fax Number	:	618-797-1745

Provider Business Practice Location Address
First Line	:	1108 ENGINEER RD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-2890
Country	:	US
Telephone Number	:	618-797-2320
Fax Number	:	618-797-1745

Authorized Official
Title or Position	:	ACCOUNTING MANAGER
Name	:	SUSAN L STAFSTROM
Credential	:
Telephone Number	:	618-465-0044

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	08/22/2020

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Directions to “RESIDENTIAL OPTIONS, INC. ” Practice Location

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