Provider Demographics
NPI:1932343613
Name:COMMUNITY SERVICE INC.
Entity Type:Organization
Organization Name:COMMUNITY SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-327-9788
Mailing Address - Street 1:818 N CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4711
Mailing Address - Country:US
Mailing Address - Phone:510-327-9788
Mailing Address - Fax:
Practice Address - Street 1:818 N CREEK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4711
Practice Address - Country:US
Practice Address - Phone:510-327-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101YA0400XMedicaid
AR101YA0400XMedicare PIN
AR101YA0400XMedicaid
AR101YA0400XMedicare Oscar/Certification