Community Life Skills Agency

Primary specialty

HomemakerTaxonomy code 376J00000X

License

C3922881 Issued in CA

Legal business name

COMMUNITY LIFE SKILLS AGENCY

Practice address

5920 Thornton Ave Ste C
Newark, CA 94560-3843

Phone

(800) 398-9141

Fax

(510) 745-0105

NPI assigned

Dec 6, 2017

Last updated

Dec 6, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana Carol Hansson, BACHELOR OF SCIENCE

Title

Ceo/Program Director

Phone

(800) 398-9141

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1669987145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 THORNTON AVE STE C",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945603843",
            "telephone_number": "800-398-9141",
            "fax_number": "510-745-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 THORNTON AVE STE C",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945603843",
            "telephone_number": "800-398-9141",
            "fax_number": "510-745-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIFE SKILLS AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "HANSSON",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "CAROL",
        "authorized_official_title_or_position": "CEO/PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "800-398-9141",
        "authorized_official_credential": "BACHELOR OF SCIENCE"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Homemaker",
            "state": "CA",
            "license": "C3922881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Homemaker in Newark, CA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.