MEDICARE: COMMUNITY LIVING AND SUPPORT SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1134783178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY LIVING AND SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	1400 S BRADDOCK AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1264
Country	:	US
Telephone Number	:	412-246-2136
Fax Number	:	412-683-4160

Provider Business Practice Location Address
First Line	:	1400 S BRADDOCK AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1264
Country	:	US
Telephone Number	:	412-246-2136
Fax Number	:	412-683-4160

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DAVID A BROWN
Credential	:
Telephone Number	:	412-246-2136

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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