Healthcare Provider Details

I. General information

NPI: 1093938599
Provider Name (Legal Business Name): COMMUNITY SUPPORT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 MAIN AVE S
TWIN FALLS ID
83301-6423
US

IV. Provider business mailing address

336 MAIN AVE S
TWIN FALLS ID
83301-6423
US

V. Phone/Fax

Practice location:
  • Phone: 208-737-0777
  • Fax: 208-734-5470
Mailing address:
  • Phone: 208-737-0777
  • Fax: 208-734-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ALDRICH
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-737-0777