Healthcare Provider Details

I. General information

NPI: 1083528970
Provider Name (Legal Business Name): COMMUNITY LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N BROWN RD STE 200
LAWRENCEVILLE GA
30043-2018
US

IV. Provider business mailing address

1755 N BROWN RD STE 200
LAWRENCEVILLE GA
30043-2018
US

V. Phone/Fax

Practice location:
  • Phone: 515-988-7748
  • Fax:
Mailing address:
  • Phone: 515-988-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELLY ANYIKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 515-988-7748