Provider Demographics
NPI:1851617062
Name:COMMUNITY SUPPORT NETWORKR
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT NETWORKR
Other - Org Name:OPORTUNITY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:COUNSELOR
Authorized Official - Phone:707-573-6955
Mailing Address - Street 1:634 PRESSLEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5526
Mailing Address - Country:US
Mailing Address - Phone:707-573-6955
Mailing Address - Fax:707-543-8176
Practice Address - Street 1:634 PRESSLEY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5526
Practice Address - Country:US
Practice Address - Phone:707-573-6955
Practice Address - Fax:707-543-8176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY SUPPORT NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56789OtherMEDICAL