Healthcare Provider Details

I. General information

NPI: 1083576573
Provider Name (Legal Business Name): CORE COMMUNITY SUPPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 S LA BREA AVE
LOS ANGELES CA
90056-1803
US

IV. Provider business mailing address

4500 PARK GRANADA STE 202
CALABASAS CA
91302-1666
US

V. Phone/Fax

Practice location:
  • Phone: 323-204-0200
  • Fax: 323-204-0220
Mailing address:
  • Phone: 323-204-0200
  • Fax: 323-204-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA JAMES KLEINBERGS
Title or Position: PROGRAM DIRECTOR
Credential: MSW
Phone: 323-204-0200