Organization
CLARK SUPPORTED LIVING
Active
Other names
CSL Missouri
Organization subpart
No
Provider details
NPI number
Authorized official
ZONDRA D CLARK RN (EXECUTIVE DIRECTOR)
(773) 332-6106
Entity
Organization
Contact information
Practice address
303 MACAW DR, COLUMBIA, MO 65202
(773) 332-6106
Mailing address
303 MACAW DR, COLUMBIA, MO 65202-6284
(773) 332-6106
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
—
—
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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