Provider Demographics
NPI:1720021512
Name:COMMUNITY LIVING, INC
Entity Type:Organization
Organization Name:COMMUNITY LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEBAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-665-7681
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-0006
Mailing Address - Country:US
Mailing Address - Phone:260-665-7681
Mailing Address - Fax:260-665-1501
Practice Address - Street 1:1102 W MILL ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1344
Practice Address - Country:US
Practice Address - Phone:260-665-7681
Practice Address - Fax:260-665-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities