Provider Demographics
NPI:1629226949
Name:COMMUNITY SUPPORTS PROGRAMMING SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORTS PROGRAMMING SERVICES LLC
Other - Org Name:CSPS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:QDDS, BA
Authorized Official - Phone:320-629-6674
Mailing Address - Street 1:500 3RD AVE SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063
Mailing Address - Country:US
Mailing Address - Phone:320-629-6674
Mailing Address - Fax:320-629-6630
Practice Address - Street 1:500 3RD AVE SE
Practice Address - Street 2:SUITE 2
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063
Practice Address - Country:US
Practice Address - Phone:320-629-6674
Practice Address - Fax:320-629-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN486667300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN486667300OtherMA