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Organization
COMMUNITY LIVING, INC
Active
Organization
COMMUNITY LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY THIEBAUT (PRESIDENT)
(260) 665-7681
Entity
Organization
Contact information
Practice address
429 N SUPERIOR ST, ANGOLA, IN 46703-1442
(260) 665-7681
Mailing address
PO BOX 6, ANGOLA, IN 46703-0006
(260) 665-7681
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
2511I0007DE04
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235290
—
IN
Enumeration date
12/24/2009
Last updated
12/24/2009
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