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General NPI Number Information
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NPI Number | 1093590465
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Entity Type | Organization
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Legal Business Name | COMMON GROUND SUPPORT
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 699 SALISBURY RD
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-8524
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Country | US
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Telephone | 732-685-2991
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Fax |
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Provider Business Mailing Address
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Address Line | 622 FREMONT AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6071
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Country | US
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Telephone | 732-685-2991
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN TYRONE ROGERS
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Credential |
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Telephone | 732-685-2991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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