COMMUNITY LIVING ASSOCIATION

Provider Demographics

• NPI: 1144274564
• Name: COMMUNITY LIVING ASSOCIATION
• Entity type: Organization
• Organization Name: COMMUNITY LIVING ASSOCIATION
• Authorized Official - Title/Position: FINANCE MANAGER
• Authorized Official - Prefix: MR
• Authorized Official - First Name: SHANNON
• Authorized Official - Middle Name: JON
• Authorized Official - Last Name: HOGAN
• Authorized Official - Phone: 207-532-9446
• Mailing Address - Street 1: 45 SCHOOL ST
• Mailing Address - City: HOULTON
• Mailing Address - State: ME
• Mailing Address - Zip Code: 04730-2010
• Mailing Address - Country: US
• Mailing Address - Phone: 207-532-9446
• Mailing Address - Fax: 207-532-1359
• Practice Address - Street 1: 45 SCHOOL ST
• Practice Address - City: HOULTON
• Practice Address - State: ME
• Practice Address - Zip Code: 04730-2010
• Practice Address - Country: US
• Practice Address - Phone: 207-532-9446
• Practice Address - Fax: 207-532-1359
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-20
• Last Update Date: 2010-06-10

Provider Licenses

State	License ID	Taxonomies
ME	36310	320600000X
ME	ALLS2160	320600000X
ME	ALLS2161	320600000X
ME	ALLS1110	320600000X
ME	ALLS2148	320600000X
ME	ALLS2155	320600000X
ME	ALLS2154	320600000X
ME	ALLS2193	320600000X
ME	ALLS2147	320600000X
ME	36274	251J00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	251J00000X	Agencies	Nursing Care
No	320600000X	Residential Treatment Facilities	Residential Treatment Facility, Intellectual and/or Developmental Disabilities

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ME	104190100	Medicaid
ME	104190209	Medicaid
ME	104190200	Medicaid
ME	104190202	Medicaid
ME	104190205	Medicaid
ME	104190204	Medicaid
ME	104190207	Medicaid
ME	104190208	Medicaid
ME	104190210	Medicaid
ME	104190101	Medicaid
ME	104190206	Medicaid
ME	104190000	Medicaid
ME	104190201	Medicaid
ME	104190203	Medicaid
ME	431576700	Medicaid