Provider Demographics
NPI:1700598588
Name:COMMUNITY SERVICES TO SUPPORT INDEPENDENCE
Entity Type:Organization
Organization Name:COMMUNITY SERVICES TO SUPPORT INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:L-MHC
Authorized Official - Phone:917-753-9297
Mailing Address - Street 1:555 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4133
Mailing Address - Country:US
Mailing Address - Phone:646-228-9582
Mailing Address - Fax:
Practice Address - Street 1:555 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4133
Practice Address - Country:US
Practice Address - Phone:646-228-9582
Practice Address - Fax:646-228-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child