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General NPI Number Information
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NPI Number | 1750767257
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Entity Type | Organization
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Legal Business Name | COMMUNITY LIVING SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 6929 CALHOUN RD
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City | ALBION
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State | MI
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Zip | 49224-9651
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Country | US
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Telephone | 517-554-8788
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Fax | 517-465-7103
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Provider Business Mailing Address
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Address Line | 6929 CALHOUN RD
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City | ALBION
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State | MI
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Zip | 49224-9651
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Country | US
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Telephone | 517-554-8788
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Fax | 517-465-7103
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Authorized Official
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Title or Position | LICENSEE DESIGNEE, ADMINISTRATOR
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Name | RENAE MICHELLE CLARK
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Credential | BSW
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Telephone | 517-554-8788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | AS130374875
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License Number State | MI
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