MEDICARE: GOODLIVING COMMUNITY 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1851680375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODLIVING COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	2007 PLAINVIEW AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15226-1334
Country	:	US
Telephone Number	:	412-969-7626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 PLAINVIEW AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15226-1334
Country	:	US
Telephone Number	:	412-969-7626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW M TAYLOR
Credential	:
Telephone Number	:	412-969-7626

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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