Healthcare Provider Details

I. General information

NPI: 1326657602
Provider Name (Legal Business Name): COMMUNITY LIVING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 28TH ST S
FARGO ND
58103-2372
US

IV. Provider business mailing address

1001 28TH ST S
FARGO ND
58103-2372
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3133
  • Fax:
Mailing address:
  • Phone: 701-232-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AARON CHAPMAN
Title or Position: CONTROLLER
Credential:
Phone: 701-232-3133