OrganizationActive
Community Living, Inc
NPI 1316980774 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Angola, IN
Provider details
- NPI number
- 1316980774
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Randy Thiebaut, President(260) 665-7681
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
2000 W 175 N
Angola, IN 46703-7117
Phone: (260) 665-7681
Fax: (260) 665-1501
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 393
Angola, IN 46703-0393
Registry dates
- Enumerated
- 2006-06-14
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.