Provider Demographics
NPI:1134348220
Name:RESIDENTIAL OPTIONS, INC.
Entity type:Organization
Organization Name:RESIDENTIAL OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-465-0044
Mailing Address - Street 1:821 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-2757
Mailing Address - Country:US
Mailing Address - Phone:618-474-2020
Mailing Address - Fax:618-474-0714
Practice Address - Street 1:821 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-2757
Practice Address - Country:US
Practice Address - Phone:618-474-2020
Practice Address - Fax:618-474-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035907320900000X
315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6012397OtherPUBLIC HEALTH
IL6012397OtherPUBLIC HEALTH