Provider Demographics
NPI:1639944614
Name:COMMUNITY SUPPORT NETWORK OF GREATER DC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT NETWORK OF GREATER DC
Other - Org Name:COMMUNITY SUPPORT NETWORK OF GREATER DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TEACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-613-9223
Mailing Address - Street 1:2005 BUNKER HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3223
Mailing Address - Country:US
Mailing Address - Phone:301-613-9223
Mailing Address - Fax:
Practice Address - Street 1:2005 BUNKER HILL RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3223
Practice Address - Country:US
Practice Address - Phone:301-613-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities