OrganizationActive
Residential Options
NPI 1316166382 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Granite City, IL
Provider details
- NPI number
- 1316166382
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Susan Stafstrom, Accounting Manager(618) 465-0044
- License
- 0036905 (IL)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 0036905 (IL)
Residential Treatment Facilities
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
56 Chouteau Trace Pkwy
Granite City, IL 62040-6710
Phone: (618) 797-2262
Fax: (618) 797-2264
Street-level locationGet directions
Mailing address
56 Chouteau Trace Pkwy
Granite City, IL 62040-6710
Registry dates
- Enumerated
- 2007-04-25
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.