Healthcare Provider Details

I. General information

NPI: 1447708482
Provider Name (Legal Business Name): COMMUNITY SUPPORTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LODGE TERRACE DR
ALTOONA FL
32702-9668
US

IV. Provider business mailing address

1890 STATE ROAD 436 SUITE 300
WINTER PARK FL
32792-2228
US

V. Phone/Fax

Practice location:
  • Phone: 352-669-2133
  • Fax: 352-669-1170
Mailing address:
  • Phone: 407-645-3211
  • Fax: 407-628-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12860961
License Number StateFL

VIII. Authorized Official

Name: MR. KENNETH SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 407-645-3211