MEDICARE: COMMUNITY SUPPORT SERVICES, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	0179	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578008546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY SUPPORT SERVICES, INC.

Provider Business Mailing Address
First Line	:	9075 COMPRINT CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1306
Country	:	US
Telephone Number	:	301-926-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	9075 COMPRINT CT
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1306
Country	:	US
Telephone Number	:	301-926-2300
Fax Number	:

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	PATRICK J GRAVELINE
Credential	:	PSY.D., MHA, BCBA-D
Telephone Number	:	301-926-2300

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	12/30/2016

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