Organization
COMMUNITY LIVING ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANNON JON HOGAN (FINANCE MANAGER)
(207) 532-9446
Entity
Organization
Contact information
Practice address
45 SCHOOL ST, HOULTON, ME 04730-2010
(207) 532-9446
(207) 532-1359
Mailing address
45 SCHOOL ST, HOULTON, ME 04730-2010
(207) 532-9446
(207) 532-1359
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
36274
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
36310
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS1110
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2147
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2148
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2154
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2155
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2160
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2161
ME
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS2193
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104190000
—
ME
05
—
104190100
—
ME
05
—
104190101
—
ME
05
—
104190200
—
ME
05
—
104190201
—
ME
05
—
104190202
—
ME
05
—
104190203
—
ME
05
—
104190204
—
ME
05
—
104190205
—
ME
05
—
104190206
—
ME
05
—
104190207
—
ME
05
—
104190208
—
ME
05
—
104190209
—
ME
05
—
104190210
—
ME
05
—
431576700
—
ME
Enumeration date
05/20/2006
Last updated
06/10/2010
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