Provider Demographics
NPI:1982705661
Name:COORDINATED COMMUNITY LIVING
Entity type:Organization
Organization Name:COORDINATED COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBATE-MARZOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-262-9200
Mailing Address - Street 1:29100 NORTHWESTERN HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1091
Mailing Address - Country:US
Mailing Address - Phone:248-357-2255
Mailing Address - Fax:248-948-9691
Practice Address - Street 1:29100 NORTHWESTERN HWY STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1091
Practice Address - Country:US
Practice Address - Phone:248-357-2255
Practice Address - Fax:248-948-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4508980Medicaid