MEDICARE: COMMUNITY LIVING CENTERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1528443538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY LIVING CENTERS, INC

Provider Business Mailing Address
First Line	:	33235 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3123
Country	:	US
Telephone Number	:	248-478-0870
Fax Number	:	248-478-8620

Provider Business Practice Location Address
First Line	:	33235 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-3123
Country	:	US
Telephone Number	:	248-478-0870
Fax Number	:	248-478-8620

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA MURRELL
Credential	:
Telephone Number	:	248-478-0870

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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