Provider Demographics
NPI:1083202642
Name:COMPLETE CARE SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:COMPLETE CARE SUPPORT SERVICES INC
Other - Org Name:COMPLETE CARE SUPPORT SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-521-1600
Mailing Address - Street 1:5602 BALTIMORE NATIONAL PIKE STE 306
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1410
Mailing Address - Country:US
Mailing Address - Phone:410-521-1600
Mailing Address - Fax:
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE STE 306
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1410
Practice Address - Country:US
Practice Address - Phone:410-521-1600
Practice Address - Fax:410-916-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD666569100Medicaid