Provider Demographics
NPI:1609923044
Name:CASE MANAGEMENT SUPPORT SERVICES
Entity Type:Organization
Organization Name:CASE MANAGEMENT SUPPORT SERVICES
Other - Org Name:CMSS-TSM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-878-3421
Mailing Address - Street 1:2185 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4747
Mailing Address - Country:US
Mailing Address - Phone:814-878-3400
Mailing Address - Fax:814-878-3401
Practice Address - Street 1:2185 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4747
Practice Address - Country:US
Practice Address - Phone:814-878-3400
Practice Address - Fax:814-878-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000039900004Medicaid