Healthcare Provider Details

I. General information

NPI: 1750660908
Provider Name (Legal Business Name): COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3813 N 52ND ST
MILWAUKEE WI
53216-2307
US

IV. Provider business mailing address

3813 N 52ND ST
MILWAUKEE WI
53216-2307
US

V. Phone/Fax

Practice location:
  • Phone: 414-839-4755
  • Fax:
Mailing address:
  • Phone: 414-839-4755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANESE MCCLENDON
Title or Position: DIRECTOR
Credential:
Phone: 414-839-4755