Provider Demographics
NPI:1497194377
Name:COMMUNITY NETWORK SERVICES
Entity Type:Organization
Organization Name:COMMUNITY NETWORK SERVICES
Other - Org Name:COMMUNITY NETWORK SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RN CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-871-1427
Mailing Address - Street 1:38855 HILLS TECH DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3421
Mailing Address - Country:US
Mailing Address - Phone:248-871-1427
Mailing Address - Fax:
Practice Address - Street 1:38855 HILLS TECH DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3421
Practice Address - Country:US
Practice Address - Phone:248-871-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704275429251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management