Provider Demographics
NPI:1629554555
Name:CSI COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:CSI COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-205-7978
Mailing Address - Street 1:1400 OHIO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2935
Mailing Address - Country:US
Mailing Address - Phone:304-205-7978
Mailing Address - Fax:304-205-7984
Practice Address - Street 1:1400 OHIO AVE STE A
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2935
Practice Address - Country:US
Practice Address - Phone:304-205-7978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CSI COMMUNITY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-13
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3501003000Medicaid