Provider Demographics
NPI:1760754964
Name:COMFORTABLE LIVING INCORPORATED
Entity Type:Organization
Organization Name:COMFORTABLE LIVING INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:KARLTON
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:612-607-4233
Mailing Address - Street 1:6008 69TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1553
Mailing Address - Country:US
Mailing Address - Phone:612-607-4233
Mailing Address - Fax:
Practice Address - Street 1:6008 69TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55429-1553
Practice Address - Country:US
Practice Address - Phone:612-607-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization