Healthcare Provider Details

I. General information

NPI: 1336417641
Provider Name (Legal Business Name): COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5062 N 19TH AVE STE 102
PHOENIX AZ
85015-3225
US

IV. Provider business mailing address

10645 N TATUM BLVD
PHOENIX AZ
85028-3068
US

V. Phone/Fax

Practice location:
  • Phone: 480-629-5994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH-3873
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARLETTE ITAMI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 480-629-5994