Provider Demographics
NPI:1770871246
Name:CENTER FOR COMPREHENSIVE SERVICES
Entity type:Organization
Organization Name:CENTER FOR COMPREHENSIVE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:LOREYONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-626-1444
Mailing Address - Street 1:10150 HIGHLAND MANOR DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9713
Mailing Address - Country:US
Mailing Address - Phone:813-626-1444
Mailing Address - Fax:813-621-0770
Practice Address - Street 1:12312 MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1547
Practice Address - Country:US
Practice Address - Phone:301-352-2979
Practice Address - Fax:301-262-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD631801100Medicaid