Healthcare Provider Details

I. General information

NPI: 1093220915
Provider Name (Legal Business Name): COMMUNITY LIVING OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 REED AVE
KALAMAZOO MI
49001-2971
US

IV. Provider business mailing address

626 REED AVE
KALAMAZOO MI
49001-2971
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-6355
  • Fax: 269-343-0054
Mailing address:
  • Phone: 269-343-6355
  • Fax: 269-343-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801099636
License Number StateMI

VIII. Authorized Official

Name: LORINDA JUNE ANDERSON
Title or Position: DIRECTOR QA
Credential:
Phone: 269-343-6355