Healthcare Provider Details

I. General information

NPI: 1023851722
Provider Name (Legal Business Name): COMMUNITY SUPPORT PS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13739 S HURON RIVER DR
ROMULUS MI
48174-3628
US

IV. Provider business mailing address

13739 S HURON RIVER DR
ROMULUS MI
48174-3628
US

V. Phone/Fax

Practice location:
  • Phone: 248-561-4848
  • Fax:
Mailing address:
  • Phone: 248-561-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEWIS HALL
Title or Position: OWNER
Credential:
Phone: 248-561-4848