Provider Demographics
NPI:1134783178
Name:COMMUNITY LIVING AND SUPPORT SERVICES
Entity type:Organization
Organization Name:COMMUNITY LIVING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-246-2136
Mailing Address - Street 1:1400 S BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1264
Mailing Address - Country:US
Mailing Address - Phone:412-246-2136
Mailing Address - Fax:412-683-4160
Practice Address - Street 1:1400 S BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1264
Practice Address - Country:US
Practice Address - Phone:412-246-2136
Practice Address - Fax:412-683-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty