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General NPI Number Information
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NPI Number | 1780610923
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Entity Type | Organization
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Legal Business Name | COMMUNITY SERVICE ASSOCIATES, SC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 2901 HUNTERS TRL
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City | PORTAGE
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State | WI
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Zip | 53901-3403
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Country | US
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Telephone | 608-742-5518
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Fax | 608-742-4087
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Provider Business Mailing Address
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Address Line | PO BOX 301 2901 HUNTERS TRAIL
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City | PORTAGE
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State | WI
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Zip | 53901-3403
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Country | US
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Telephone | 608-742-5518
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Fax | 608-742-4087
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Authorized Official
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Title or Position | CREDENTIALING DEPT/BUSINESS MANAGER
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Name | SHERRY D STEVENS
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Credential |
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Telephone | 608-742-5518
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2149
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License Number State | WI
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