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	251C00000X	Developmentally Disabled Services Day Training Agency	11173601	PA
2	253Z00000X	In Home Supportive Care Agency	12973601	PA
3	332B00000X	Durable Medical Equipment & Medical Supplies	6000005377	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679576573
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	:	412-683-7100
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	:	412-683-7100
Fax Number	:	412-683-4160

Authorized Official
Title or Position	:	CHIEF EXECUTIVE DIRECTOR
Name	:	DR. AL CONDELUCI
Credential	:	PHD
Telephone Number	:	412-683-7100

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/29/2018

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Directions to “COMMUNITY LIVING AND SUPPORT SERVICES ” Practice Location

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