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General NPI Number Information
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NPI Number | 1265711600
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTEGRATED LIVING, INC.
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 110 JENI LANE
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City | ANNA
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State | IL
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Zip | 62906
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Country | US
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Telephone | 618-697-1122
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Fax | 618-833-1360
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Provider Business Mailing Address
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Address Line | 2465 LICK CREEK RD
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City | ANNA
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State | IL
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Zip | 62906-3269
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Country | US
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Telephone | 618-697-1122
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Fax | 618-833-1360
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DON J. PIPPINS
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Credential | LNHA
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Telephone | 618-697-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 09M012
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License Number State | IL
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