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
2000 W 175 N, ANGOLA, IN 46703-7117
(260) 665-7681
(260) 665-1501
Mailing address
PO BOX 393, ANGOLA, IN 46703-0393
(260) 665-7681
(260) 665-1501
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/14/2006
Last updated
08/22/2020
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