Provider Demographics
NPI:1235738824
Name:COMMUNITY INTEGRATED SERVICES
Entity Type:Organization
Organization Name:COMMUNITY INTEGRATED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHONFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-870-7667
Mailing Address - Street 1:441 N 5TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-4009
Mailing Address - Country:US
Mailing Address - Phone:215-870-7667
Mailing Address - Fax:215-238-7423
Practice Address - Street 1:441 N 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4009
Practice Address - Country:US
Practice Address - Phone:215-870-7667
Practice Address - Fax:215-238-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250604976Medicaid
DE000000060Medicaid
DE000000057Medicaid