# CLARK SUPPORTED LIVING

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CSL Missouri
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326514381
- **Authorized official:** ZONDRA D CLARK RN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (773) 332-6106

## Contact information

- **Practice address:** 303 MACAW DR, COLUMBIA, MO 65202
- **Practice address phone:** (773) 332-6106
- **Mailing address:** 303 MACAW DR, COLUMBIA, MO 65202-6284
- **Mailing address phone:** (773) 332-6106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC1500X | Community Health Registered Nurse | — | NULL | — |
| 163WC1500X | Community Health Registered Nurse | — | — | — |
| 174200000X | Meals Provider | — | NULL | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 251X00000X | Supports Brokerage Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QA0600X | Adult Day Care Clinic/Center | — | NULL | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |
| 385HR2055X | Child Mental Illness Respite Care | — | NULL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |
| 385HR2065X | Child Physical Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 10/17/2018
- **Last updated:** 10/17/2018