Provider Demographics
NPI:1790065308
Name:CNS PERSONAL SERVICE AGENCY LLC
Entity Type:Organization
Organization Name:CNS PERSONAL SERVICE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:219-750-1200
Mailing Address - Street 1:6124 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2641
Mailing Address - Country:US
Mailing Address - Phone:219-750-1200
Mailing Address - Fax:219-750-1211
Practice Address - Street 1:5209 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1719
Practice Address - Country:US
Practice Address - Phone:219-750-1200
Practice Address - Fax:219-720-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN110126561253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11-012656-1OtherINDIANA STATE DEPARTMENT OF HEALTH