Provider Demographics
NPI:1609037589
Name:COMMUNITY BASED SERVICES AND CONSULTING GROUP INC
Entity Type:Organization
Organization Name:COMMUNITY BASED SERVICES AND CONSULTING GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:DEXTER
Authorized Official - Last Name:STANDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-465-3551
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34430-1108
Mailing Address - Country:US
Mailing Address - Phone:352-465-3551
Mailing Address - Fax:352-465-3549
Practice Address - Street 1:12948 SW 62ND STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-3459
Practice Address - Country:US
Practice Address - Phone:352-465-3551
Practice Address - Fax:352-465-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686171796Medicaid