Provider Demographics
NPI:1942490586
Name:COMMUNITY LIVING ALTERNATIVES - ICF
Entity Type:Organization
Organization Name:COMMUNITY LIVING ALTERNATIVES - ICF
Other - Org Name:CLA - ICF
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SILVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-352-0388
Mailing Address - Street 1:9401 LEE HWY
Mailing Address - Street 2:#406
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1849
Mailing Address - Country:US
Mailing Address - Phone:703-352-0388
Mailing Address - Fax:
Practice Address - Street 1:4123 CONRAD RD
Practice Address - Street 2:(FORMERLY COURHOUSE ROAD ICF)
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1155
Practice Address - Country:US
Practice Address - Phone:703-352-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08502006315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities