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NPI Code Detail

MEDICARE: COMMUNITY SUPPPORT NETWORK

MEDICARE: COMMUNITY SUPPPORT NETWORK
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
1320800000XMental Illness Community Based Residential Treatment FacilityCA

General Provider Information

NPI Number : 1831219989
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY SUPPPORT NETWORK
Provider Business Mailing Address
First Line : 1410 GUERNEVILLE RD
Second Line : 14
City : SANTA ROSA
State : CA
Zip : 95403-7231
Country : US
Telephone Number : 707-575-0979
Fax Number : 707-573-6968
Provider Business Practice Location Address
First Line : 634 PRESSLEY ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-5526
Country : US
Telephone Number : 707-573-6955
Fax Number : 707-543-8176
Authorized Official
Title or Position : DIRECTOR OF SOCIAL REHABILITATION
Name : MRS. RITA LARSON
Credential :
Telephone Number : 707-575-0979
Provider Enumeration Date : 03/30/2007
Last Update Date : 06/15/2012

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Directions to “COMMUNITY SUPPPORT NETWORK ” Practice Location

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