Healthcare Provider Details

I. General information

NPI: 1841965316
Provider Name (Legal Business Name): COMMUNITY SUPPORTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9642 SW 72ND ST
MIAMI FL
33173-3250
US

IV. Provider business mailing address

9642 SW 72ND ST
MIAMI FL
33173-3250
US

V. Phone/Fax

Practice location:
  • Phone: 813-551-8110
  • Fax:
Mailing address:
  • Phone: 813-551-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LUIS CARRALERO
Title or Position: CEO
Credential:
Phone: 813-551-8110