Provider Demographics
NPI:1033535208
Name:COMMUNITY SUPPORT SOLUTIONS
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:COY-MONAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-672-8787
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-1237
Mailing Address - Country:US
Mailing Address - Phone:425-672-8787
Mailing Address - Fax:425-670-1640
Practice Address - Street 1:407 HOWELL WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4186
Practice Address - Country:US
Practice Address - Phone:425-672-8787
Practice Address - Fax:245-670-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 251T00000X, 251X00000X, 252Y00000X, 385HR2055X, 385HR2060X, 385HR2065X
WAIHS.FS.60304414253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251X00000XAgenciesSupports Brokerage
No252Y00000XAgenciesEarly Intervention Provider Agency
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child