Organization
COMMUNITY LIVING AND SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AL CONDELUCI PHD (CHIEF EXECUTIVE DIRECTOR)
(412) 683-7100
Entity
Organization
Contact information
Practice address
1400 S BRADDOCK AVE, PITTSBURGH, PA 15218-1264
(412) 683-7100
(412) 683-4160
Mailing address
1400 S BRADDOCK AVE, PITTSBURGH, PA 15218-1264
(412) 683-7100
(412) 683-4160
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
11173601
PA
253Z00000X
In Home Supportive Care Agency
12973601
PA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
6000005377
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000026610002
—
PA
05
—
1000026610033
—
PA
05
—
1000026610045
—
PA
05
—
1007170720004
—
PA
Enumeration date
05/24/2005
Last updated
03/29/2018
Update your record
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