Provider Demographics
NPI:1033286356
Name:COMMUNITY-BASED SERVICES & CONSULTING GROUP, INC.
Entity Type:Organization
Organization Name:COMMUNITY-BASED SERVICES & CONSULTING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-465-3551
Mailing Address - Street 1:16083 SW 22ND LN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-8729
Mailing Address - Country:US
Mailing Address - Phone:352-465-3551
Mailing Address - Fax:352-465-3549
Practice Address - Street 1:20491 THE GRANADA
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6064
Practice Address - Country:US
Practice Address - Phone:352-465-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686171798OtherPROVIDER ID NUMBER
FL686171796OtherPROVIDER ID NUMBER