Provider Demographics
NPI:1457772808
Name:COMMONWEALTH SUPPORTIVE SERVICES,LLC.
Entity Type:Organization
Organization Name:COMMONWEALTH SUPPORTIVE SERVICES,LLC.
Other - Org Name:SAME AS ABOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-207-1941
Mailing Address - Street 1:1602 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-1313
Mailing Address - Country:US
Mailing Address - Phone:267-207-1941
Mailing Address - Fax:
Practice Address - Street 1:1602 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1313
Practice Address - Country:US
Practice Address - Phone:267-207-1941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-01
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty