MEDICARE: COMMUNITY LIFE SUPPORT SYSTEMS, 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	3416L0300X	Land Ambulance	05096	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	290545	OTHER	PA	ACCESS CARE BCBS
2	998577	OTHER	PA	BC NEPA
3	800743	OTHER	PA	FIRST PRIORITY HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396881322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY LIFE SUPPORT SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 472
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-0472
Country	:	US
Telephone Number	:	570-586-0611
Fax Number	:	570-585-6906

Provider Business Practice Location Address
First Line	:	3 ABINGTON EXECUTIVE PARK STE 11
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-2269
Country	:	US
Telephone Number	:	570-586-0611
Fax Number	:	570-585-6906

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	TIMOTHY ROWLAND
Credential	:
Telephone Number	:	570-586-0611

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	12/02/2009

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Directions to “COMMUNITY LIFE SUPPORT SYSTEMS, INC. ” Practice Location

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