Healthcare Provider Details

I. General information

NPI: 1760894919
Provider Name (Legal Business Name): COMMUNITY SUPPORT SERVICES OF THE CAPITAL DISTRICT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 MADISON AVE
TROY NY
12180-5009
US

IV. Provider business mailing address

1076 MADISON AVE
TROY NY
12180-5009
US

V. Phone/Fax

Practice location:
  • Phone: 518-944-9215
  • Fax:
Mailing address:
  • Phone: 518-944-9215
  • 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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DANIELLA LANS
Title or Position: EXECTUTIVE DIRECTOR
Credential:
Phone: 518-944-9215