Provider Demographics
NPI:1740031533
Name:COMMUNITY ASSISTED AND SUPPORTED LIVING, INC.
Entity type:Organization
Organization Name:COMMUNITY ASSISTED AND SUPPORTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-225-2373
Mailing Address - Street 1:2911 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5320
Mailing Address - Country:US
Mailing Address - Phone:941-928-1814
Mailing Address - Fax:941-366-0033
Practice Address - Street 1:461 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-3740
Practice Address - Country:US
Practice Address - Phone:239-922-1969
Practice Address - Fax:941-366-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness