Provider Demographics
NPI:1336540061
Name:COMMUNITY SUPPORT SYSTEM LLC
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-960-4223
Mailing Address - Street 1:4920 NIAGARA RD STE 402
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1158
Mailing Address - Country:US
Mailing Address - Phone:301-960-4223
Mailing Address - Fax:
Practice Address - Street 1:4920 NIAGARA RD STE 402
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1158
Practice Address - Country:US
Practice Address - Phone:301-960-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2529251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health