Provider Demographics
NPI:1275678500
Name:COMMUNITY LIVING CORPORATION
Entity Type:Organization
Organization Name:COMMUNITY LIVING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-241-3628
Mailing Address - Street 1:105 SOUTH BEDFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-241-3628
Mailing Address - Fax:914-241-1109
Practice Address - Street 1:105 SOUTH BEDFORD ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-3628
Practice Address - Fax:914-241-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02247230Medicaid
NY02247258Medicaid
NY01387842Medicaid
NY01997286Medicaid
NY02557931Medicaid
NY02171819Medicaid
NY02557940Medicaid