Provider Demographics
NPI:1235428095
Name:COMMUNITY SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:COMMUNITY SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-454-1219
Mailing Address - Street 1:3520 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1918
Mailing Address - Country:US
Mailing Address - Phone:314-454-1219
Mailing Address - Fax:314-454-1382
Practice Address - Street 1:3520 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1918
Practice Address - Country:US
Practice Address - Phone:314-454-1219
Practice Address - Fax:314-454-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness