Healthcare Provider Details

I. General information

NPI: 1235249285
Provider Name (Legal Business Name): COMMUNITY SUPPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TERRACE WAY STE A
GREENSBORO NC
27403-3667
US

IV. Provider business mailing address

PO BOX 20933
GREENSBORO NC
27420-0933
US

V. Phone/Fax

Practice location:
  • Phone: 336-855-1810
  • Fax: 336-855-1834
Mailing address:
  • Phone: 336-855-1810
  • Fax: 336-855-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. REGINA FERGUSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-855-1810