MEDICARE: COMMUNITY SUPPORTED TRAINING ORGANZIATION INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	519-03-011	VA

General Provider Information

NPI Number	:	1295894160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY SUPPORTED TRAINING ORGANZIATION INC.

Provider Business Mailing Address
First Line	:	2428 ALMEDA AVE
Second Line	:	SUITE 156
City	:	NORFOLK
State	:	VA
Zip	:	23513-2448
Country	:	US
Telephone Number	:	757-853-2815
Fax Number	:	757-853-2816

Provider Business Practice Location Address
First Line	:	2428 ALMEDA AVE
Second Line	:	SUITE 156
City	:	NORFOLK
State	:	VA
Zip	:	23513-2448
Country	:	US
Telephone Number	:	757-853-2815
Fax Number	:	757-853-2816

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MICHAEL N EBONG
Credential	:
Telephone Number	:	757-362-6485

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	08/22/2020

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