Provider Demographics
NPI:1679265748
Name:COMMUNITY DIRECT LLC
Entity Type:Organization
Organization Name:COMMUNITY DIRECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:KIMANI
Authorized Official - Last Name:MWANGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-386-6705
Mailing Address - Street 1:7704 S 29TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7138
Mailing Address - Country:US
Mailing Address - Phone:858-386-6705
Mailing Address - Fax:623-800-7599
Practice Address - Street 1:500 W SOUTHERN AVE STE 9
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5020
Practice Address - Country:US
Practice Address - Phone:858-386-6705
Practice Address - Fax:623-800-7599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENCHMARK VALLEY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health