MEDICARE: CONTEMPORARY LIVING OPTIONS, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency		MO

General Provider Information

NPI Number	:	1174665608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTEMPORARY LIVING OPTIONS, INC.

Provider Business Mailing Address
First Line	:	4144 LINDELL BLVD
Second Line	:	SUITE #318
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2927
Country	:	US
Telephone Number	:	314-535-9391
Fax Number	:	314-535-0064

Provider Business Practice Location Address
First Line	:	4144 LINDELL BLVD
Second Line	:	SUITE #318
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2927
Country	:	US
Telephone Number	:	314-535-9391
Fax Number	:	314-535-0064

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ANETTA BOLDEN-ROBERTS
Credential	:
Telephone Number	:	314-535-9391

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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