Provider Demographics
NPI:1104259449
Name:CSI PRIVATE DUTY SERVICES, INC
Entity type:Organization
Organization Name:CSI PRIVATE DUTY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BONACCORSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-762-9999
Mailing Address - Street 1:33 S STATE ST FL 5
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2804
Mailing Address - Country:US
Mailing Address - Phone:312-762-9999
Mailing Address - Fax:
Practice Address - Street 1:2646 SW MAPP RD STE 305
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2758
Practice Address - Country:US
Practice Address - Phone:772-221-9363
Practice Address - Fax:866-961-3463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREGIVER SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-09
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679119108Medicaid
FL679119108Medicaid