Provider Demographics
NPI:1437502705
Name:COMMUNITY LIVING ALTERNATIVES, INC
Entity Type:Organization
Organization Name:COMMUNITY LIVING ALTERNATIVES, INC
Other - Org Name:C.L.A.S.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KENYON-MOHRLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-745-8015
Mailing Address - Street 1:14252 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1432
Mailing Address - Country:US
Mailing Address - Phone:303-745-8015
Mailing Address - Fax:303-745-1126
Practice Address - Street 1:1770 S HELENA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5009
Practice Address - Country:US
Practice Address - Phone:303-872-3188
Practice Address - Fax:303-745-1126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY LIVING ALTERNATIVES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COT2021251C00000X
COT2019251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09141037Medicaid