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General NPI Number Information
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NPI Number | 1144274564
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIVING ASSOCIATION
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 45 SCHOOL ST
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City | HOULTON
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State | ME
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Zip | 04730-2010
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Country | US
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Telephone | 207-532-9446
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Fax | 207-532-1359
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Provider Business Mailing Address
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Address Line | 45 SCHOOL ST
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City | HOULTON
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State | ME
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Zip | 04730-2010
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Country | US
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Telephone | 207-532-9446
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Fax | 207-532-1359
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Authorized Official
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Title or Position | FINANCE MANAGER
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Name | MR. SHANNON JON HOGAN
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Credential |
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Telephone | 207-532-9446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 36310
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2160
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2161
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS1110
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2148
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2155
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License Number State | ME
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Taxonomy #7
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2154
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License Number State | ME
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Taxonomy #8
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2193
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License Number State | ME
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Taxonomy #9
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | ALLS2147
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License Number State | ME
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Taxonomy #10
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 36274
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License Number State | ME
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