Provider Demographics
NPI:1578720249
Name:COMMUNITY LIVING AND ADVOCACY SUPPORTS INC
Entity Type:Organization
Organization Name:COMMUNITY LIVING AND ADVOCACY SUPPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-475-1383
Mailing Address - Street 1:34 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1503
Mailing Address - Country:US
Mailing Address - Phone:518-584-6340
Mailing Address - Fax:
Practice Address - Street 1:34 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1503
Practice Address - Country:US
Practice Address - Phone:518-584-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02007207Medicaid
NY01997731Medicaid