Healthcare Provider Details

I. General information

NPI: 1962328252
Provider Name (Legal Business Name): COMMUNITY LIFE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S GODDARD RD
GODDARD KS
67052-9267
US

IV. Provider business mailing address

813 S GODDARD RD
GODDARD KS
67052-9267
US

V. Phone/Fax

Practice location:
  • Phone: 316-765-2441
  • Fax:
Mailing address:
  • Phone: 316-765-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. BAYLEE PHARMS
Title or Position: CEO
Credential:
Phone: 316-765-2441