Provider Demographics
NPI:1316036486
Name:COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARINA WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-354-4547
Mailing Address - Street 1:9021 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513
Mailing Address - Country:US
Mailing Address - Phone:708-354-4547
Mailing Address - Fax:708-354-7412
Practice Address - Street 1:9021 OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513
Practice Address - Country:US
Practice Address - Phone:708-354-4547
Practice Address - Fax:708-354-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150010241104100000X
IL178005304104100000X
IL251B00000X
IL199400214C320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty