Provider Demographics
NPI:1831319854
Name:COMMUNITY INDEPENDENT LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY INDEPENDENT LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-795-0096
Mailing Address - Street 1:940 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-1728
Mailing Address - Country:US
Mailing Address - Phone:985-795-0096
Mailing Address - Fax:985-839-5114
Practice Address - Street 1:940 ELLIS ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1728
Practice Address - Country:US
Practice Address - Phone:985-795-0096
Practice Address - Fax:985-839-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7085251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1564729Medicaid