Provider Demographics
NPI:1568545655
Name:COMMUNITY LIVING SERVICES
Entity Type:Organization
Organization Name:COMMUNITY LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:SHAFFREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-943-7911
Mailing Address - Street 1:1304 IVY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-2625
Mailing Address - Country:US
Mailing Address - Phone:540-943-7911
Mailing Address - Fax:540-943-7918
Practice Address - Street 1:1304 IVY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-2625
Practice Address - Country:US
Practice Address - Phone:540-943-7911
Practice Address - Fax:540-943-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA500-01-001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities