Organization
COMMUNITY LIVING ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD COSTELLO MSN, MBA (EXECUTIVE DIRECTOR)
(608) 242-8335
Entity
Organization
Contact information
Practice address
1414 MACARTHUR RD, MADISON, WI 53714-1318
(608) 242-8335
(608) 240-7060
Mailing address
PO BOX 8028, 1414 MACARTHUR RD., MADISON, WI 53708-8028
(608) 242-8335
(608) 240-7060
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100012562
—
WI
Enumeration date
10/17/2016
Last updated
10/17/2016
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