Provider Demographics
NPI:1093119935
Name:COMMUNITY SUPPORT HEALTHCARE LLC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT HEALTHCARE LLC
Other - Org Name:COMMUNITY SUPPORT HEALTHCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-793-8703
Mailing Address - Street 1:5680 KING CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5742
Mailing Address - Country:US
Mailing Address - Phone:301-793-8703
Mailing Address - Fax:410-975-4614
Practice Address - Street 1:5680 KING CENTRE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5742
Practice Address - Country:US
Practice Address - Phone:301-793-8703
Practice Address - Fax:410-975-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health