Provider Demographics
NPI:1649505215
Name:COMMUNITY SMART, INC.
Entity type:Organization
Organization Name:COMMUNITY SMART, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:OK HEE
Authorized Official - Last Name:STAHULJAK
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR OF SCIENCE
Authorized Official - Phone:866-236-2411
Mailing Address - Street 1:PO BOX 7036
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-0036
Mailing Address - Country:US
Mailing Address - Phone:866-236-2411
Mailing Address - Fax:866-236-2411
Practice Address - Street 1:205 PHOEBUS DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9509
Practice Address - Country:US
Practice Address - Phone:866-236-2411
Practice Address - Fax:866-236-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency