Provider Demographics
NPI:1518423615
Name:CARMEL COMMUNITY LIVING CORPORATION
Entity Type:Organization
Organization Name:CARMEL COMMUNITY LIVING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-660-1844
Mailing Address - Street 1:1607 CAPITOL AVE # 423
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4525
Mailing Address - Country:US
Mailing Address - Phone:307-365-6055
Mailing Address - Fax:
Practice Address - Street 1:1607 CAPITOL AVE # 423
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4525
Practice Address - Country:US
Practice Address - Phone:307-365-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty