Organization
COMMUNITY LIVING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E PORCELLA PHD (EXECUTIVE DIRECTOR)
(914) 241-3628
Entity
Organization
Contact information
Practice address
105 SOUTH BEDFORD ROAD, MOUNT KISCO, NY 10549
(914) 241-3628
(914) 241-1109
Mailing address
105 SOUTH BEDFORD ROAD, MOUNT KISCO, NY 10549
(914) 241-3628
(914) 241-1109
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01387842
—
NY
05
—
01997286
—
NY
05
—
02171819
—
NY
05
—
02247230
—
NY
05
—
02247258
—
NY
05
—
02557931
—
NY
05
—
02557940
—
NY
Enumeration date
02/21/2007
Last updated
08/22/2020
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