Healthcare Provider Details

I. General information

NPI: 1972706943
Provider Name (Legal Business Name): COMMUNITY INDEPENDENT LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 ELLIS ST
FRANKLINTON LA
70438-1728
US

IV. Provider business mailing address

940 ELLIS ST
FRANKLINTON LA
70438-1728
US

V. Phone/Fax

Practice location:
  • Phone: 985-795-0096
  • Fax: 985-839-5114
Mailing address:
  • Phone: 985-795-0096
  • Fax: 985-839-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. MYRNA GOINGS
Title or Position: DIRECTOR
Credential:
Phone: 985-795-0096