Provider Demographics
NPI:1386398121
Name:INTEGRATED COMMUNITY LIVING AND PARTICIPATION, INC
Entity type:Organization
Organization Name:INTEGRATED COMMUNITY LIVING AND PARTICIPATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTUVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIVINGSTONE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-347-5652
Mailing Address - Street 1:2333 W HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3684
Mailing Address - Country:US
Mailing Address - Phone:484-221-8118
Mailing Address - Fax:
Practice Address - Street 1:2333 W HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3684
Practice Address - Country:US
Practice Address - Phone:484-221-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care