Healthcare Provider Details

I. General information

NPI: 1679507412
Provider Name (Legal Business Name): COMMUNITY SUPPORT SERVICES OF LOUISIANA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 SHIRLEY RD
BUNKIE LA
71322-1545
US

IV. Provider business mailing address

1140 SHIRLEY RD 1140 SHIRLEY RD
BUNKIE LA
71322
US

V. Phone/Fax

Practice location:
  • Phone: 318-346-8001
  • Fax: 318-346-8005
Mailing address:
  • Phone: 318-346-8001
  • Fax: 318-346-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARYL A ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 318-346-8001