Provider Demographics
NPI:1073017364
Name:PROFESSIONAL COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTAAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-275-7907
Mailing Address - Street 1:12 CONIFER WAY
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4635
Mailing Address - Country:US
Mailing Address - Phone:908-275-7907
Mailing Address - Fax:
Practice Address - Street 1:12 CONIFER WAY
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4635
Practice Address - Country:US
Practice Address - Phone:908-275-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management