Provider Demographics
NPI:1942016589
Name:RILEY, CHRISTOPHER MATTHEW (BOA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:RILEY
Suffix:
Gender:M
Credentials:BOA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22150 BRIAN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-2771
Mailing Address - Country:US
Mailing Address - Phone:734-725-1755
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY LIVING SERVICES, INC.
Practice Address - Street 2:35425 MICHIGAN AVE. W.
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-4818
Practice Address - Country:US
Practice Address - Phone:734-725-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical