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General NPI Number Information
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NPI Number | 1215102728
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Entity Type | Organization
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Legal Business Name | COMMUNITY SUPPORT SYSTEMS, INC.
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 2014 7TH ST SE
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City | BEMIDJI
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State | MN
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Zip | 56601-5051
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Country | US
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Telephone | 218-444-6748
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Fax | 218-444-8664
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Provider Business Mailing Address
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Address Line | PO BOX 1097
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City | BEMIDJI
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State | MN
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Zip | 56619-1097
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Country | US
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Telephone | 218-444-6748
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Fax | 218-444-8664
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBIN WOLD
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Credential | MSW, LSW
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Telephone | 218-444-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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