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General NPI Number Information
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NPI Number | 1891510996
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1001 STONEMAN AVE
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City | PITTSBURG
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State | CA
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Zip | 94565-5479
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Country | US
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Telephone | 925-209-1648
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Fax |
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Provider Business Mailing Address
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Address Line | 5222 COSUMNES DR APT 41
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City | STOCKTON
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State | CA
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Zip | 95219-7208
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Country | US
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Telephone | 925-209-1648
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIE MOFFETT III
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Credential |
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Telephone | 925-209-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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