Healthcare Provider Details

I. General information

NPI: 1669533220
Provider Name (Legal Business Name): COMMUNITY LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 82ND ST
VICTORIA MN
55386-9773
US

IV. Provider business mailing address

1600 ARBORETUM BLVD
VICTORIA MN
55386
US

V. Phone/Fax

Practice location:
  • Phone: 952-443-2044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number800532
License Number StateMN

VIII. Authorized Official

Name: MONICA SCHMIDT
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-443-2048