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General NPI Number Information
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NPI Number | 1295894160
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Entity Type | Organization
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Legal Business Name | COMMUNITY SUPPORTED TRAINING ORGANZIATION INC.
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2428 ALMEDA AVE SUITE 156
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City | NORFOLK
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State | VA
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Zip | 23513-2448
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Country | US
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Telephone | 757-853-2815
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Fax | 757-853-2816
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Provider Business Mailing Address
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Address Line | 2428 ALMEDA AVE SUITE 156
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City | NORFOLK
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State | VA
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Zip | 23513-2448
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Country | US
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Telephone | 757-853-2815
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Fax | 757-853-2816
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MICHAEL N EBONG
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Credential |
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Telephone | 757-362-6485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 519-03-011
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License Number State | VA
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