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NPI Code Detail

MEDICARE: COMMUNITY LIVING RESOURCES LLC

MEDICARE: COMMUNITY LIVING RESOURCES LLC
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
1251B00000XCase Management Agency
2253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1780065425
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY LIVING RESOURCES LLC
Provider Business Mailing Address
First Line : 2927 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5415
Country : US
Telephone Number : 260-745-1200
Fax Number : 260-745-5968
Provider Business Practice Location Address
First Line : 2927 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5415
Country : US
Telephone Number : 260-745-1200
Fax Number : 260-745-5968
Authorized Official
Title or Position : CFO
Name : AARON SHAPIRO
Credential :
Telephone Number : 260-745-1200
Provider Enumeration Date : 06/17/2015
Last Update Date : 02/02/2018

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Directions to “COMMUNITY LIVING RESOURCES LLC ” Practice Location

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