Provider Demographics
NPI:1578094827
Name:COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ITAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-309-4210
Mailing Address - Street 1:10645 N TATUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:602-309-4210
Mailing Address - Fax:
Practice Address - Street 1:423 N COUNTRY CLUB DR
Practice Address - Street 2:SUITE 36
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5717
Practice Address - Country:US
Practice Address - Phone:602-309-4210
Practice Address - Fax:480-629-5996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG7618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health