COMMUNITY LIVING, INC (NPI# 1316980774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316980774 |
| Entity Type | Organization |
| Organization Name | COMMUNITY LIVING, INC |
| Practice Address |
2000 W 175 N Angola IN 46703-7117 |
| Mailing Address |
Po Box 393 Angola IN 46703-0393 |
| Practice Telephone | 2606657681 |
| Practice Fax Number | 2606651501 |
| Mailing Telephone | 2606657681 |
| Mailing Fax Number | 2606651501 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. RANDY THIEBAUT (PRESIDENT) |
| Authorized Official Telephone | 2606657681 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477882371 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 429 N Superior St, Angola, IN 46703-1442 | 2009-12-24 |
| 1720021512 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1102 W Mill St, Angola, IN 46703-1344 | 2006-06-13 |
| 1578506093 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 512 W Green St, Butler, IN 46721-1073 | 2006-06-13 |
| 1346280765 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 417 N Ash St, Butler, IN 46721-1105 | 2006-06-07 |
| 1295773109 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 413 W Oak St, Butler, IN 46721-1337 | 2006-06-03 |
| 1568409845 | Community Living, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 433 N Superior St, Angola, IN 46703-1442 | 2006-06-02 |
| 1912197559 | Community Living, Inc | Day Training, Developmentally Disabled Services | 314 E Atlantic St, South Hill, VA 23970-2006 | 2007-07-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | COMMUNITY LIVING, INC. | 11 Upton St, Boston, MA 02118 |
| Street Address |
2000 W 175 N |
| City | ANGOLA |
| State | IN |
| Zip Code | 46703-7117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629617097 | Carolyn Yvonne Davis | Registered Nurse | 909b South Darling Street, Angola, IN 46703 | 2020-01-02 |
| 1588144760 | Travis William Simmons | Chiropractor | 1220 N 200 W, Angola, IN 46703 | 2018-08-17 |
| 1386025427 | Jessica Conrad | Physical Therapist | 1913 North Wayne St, Suite D, Angola, IN 46703 | 2015-06-15 |
| 1578977385 | Amber Joy Richards | Counselor | 200 Hoosier Dr. Suite E, Angola, IN 46703 | 2014-06-19 |
| 1972874667 | Amanda Louise Traxler | Specialist/Technologist | 350 S John Mcbride Ave, Angola, IN 46703 | 2012-01-26 |
| 1659656155 | Kelly Balyeat | Pharmacist | 2012 North Wayne Street, Angola, IN 46703 | 2011-10-15 |
| 1689843930 | Erin Nicole Culler | Pharmacist | 2290 North Wayne Street, Angola, IN 46703 | 2008-02-20 |
| 1235319963 | J Andrew Stoner | Counselor | 430 N Wayne St, Suite 201, Angola, IN 46703 | 2007-11-09 |
| 1760537658 | Margaret Jean Schreiber | Nurse Practitioner | 103 Intertech Parkway, Suite A, Angola, IN 46703 | 2007-01-24 |
| 1922163120 | Tamara Lynn Watkins | Dentist | 101 N. Terrace Blvd., Angola, IN 46703 | 2006-12-27 |
| Find all providers in zip 46703 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336749910 | Aspire Residential Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11216 Harrington Ln, Fishers, IN 46038-3208 | 2020-10-31 |
| 1366041121 | Latresa Renee Sims | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1777 Armstrong St. Suite C., Portage, IN 46368 | 2020-10-22 |
| 1619528700 | A Totality of Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4302 Parrish Ave, East Chicago, IN 46312-3031 | 2019-09-20 |
| 1750851192 | Stimuli Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6670 Kinnerton Dr, Indianapolis, IN 46254-5843 | 2018-11-28 |
| 1659847168 | Assured Residential and Consulting, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5555 N Tacoma Ave Ste 101, Indianapolis, IN 46220-3551 | 2018-10-23 |
| 1427560002 | Swan Garden Home Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4906 Quail Ridge Ln, Indianapolis, IN 46254 | 2017-11-03 |
| 1477063923 | Gray Residential Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9660 Commerce Dr, Carmel, IN 46032-7641 | 2017-10-10 |
| 1700248564 | A.i.d. Residential Services, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10319 Dawsons Creek Blvd Ste E, Fort Wayne, IN 46825-1911 | 2016-03-22 |
| 1518338664 | First Steps | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 57358 Sequoia Dr, Goshen, IN 46528-8829 | 2015-10-15 |
| 1497144042 | Jennifer Whitlow | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6710 Waverhill Dr, Indianapolis, IN 46217-9101 | 2015-01-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.