Provider Demographics
NPI:1326488388
Name:COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-880-1199
Mailing Address - Street 1:PO BOX 724
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-0724
Mailing Address - Country:US
Mailing Address - Phone:208-880-1199
Mailing Address - Fax:208-939-0425
Practice Address - Street 1:963 S ORCHARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1939
Practice Address - Country:US
Practice Address - Phone:208-336-6792
Practice Address - Fax:208-336-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder