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General NPI Number Information
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NPI Number | 1740031533
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Entity Type | Organization
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Legal Business Name | COMMUNITY ASSISTED AND SUPPORTED LIVING, INC.
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 461 VAN BUREN ST
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City | FORT MYERS
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State | FL
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Zip | 33916-3740
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Country | US
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Telephone | 239-922-1969
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Fax | 941-366-0033
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Provider Business Mailing Address
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Address Line | 2911 FRUITVILLE RD
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City | SARASOTA
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State | FL
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Zip | 34237-5320
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Country | US
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Telephone | 941-928-1814
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Fax | 941-366-0033
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Authorized Official
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Title or Position | CEO
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Name | JULIAN S ELLER
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Credential |
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Telephone | 941-225-2373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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