Provider Demographics
NPI:1306405097
Name:ACCESSIBLE COMMUNITY LIVING, INC
Entity Type:Organization
Organization Name:ACCESSIBLE COMMUNITY LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-420-2006
Mailing Address - Street 1:4052 PORTLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2404
Mailing Address - Country:US
Mailing Address - Phone:314-420-2006
Mailing Address - Fax:314-355-1214
Practice Address - Street 1:4052 PORTLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2404
Practice Address - Country:US
Practice Address - Phone:314-420-2006
Practice Address - Fax:314-355-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health