Provider Demographics
NPI:1679576573
Name:COMMUNITY LIVING AND SUPPORT SERVICES
Entity type:Organization
Organization Name:COMMUNITY LIVING AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDELUCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-683-7100
Mailing Address - Street 1:1400 S BRADDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1264
Mailing Address - Country:US
Mailing Address - Phone:412-683-7100
Mailing Address - Fax:412-683-4160
Practice Address - Street 1:1400 S BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1264
Practice Address - Country:US
Practice Address - Phone:412-683-7100
Practice Address - Fax:412-683-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11173601251C00000X
PA12973601253Z00000X
PA6000005377332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000026610002Medicaid
PA1007170720004Medicaid
PA1000026610033Medicaid
PA1000026610045Medicaid
PA1007170720004Medicaid