Provider Demographics
NPI:1538301783
Name:COMPREHENSIVE COMMUNITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHELMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-925-5611
Mailing Address - Street 1:1713 WOODDALE BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1570
Mailing Address - Country:US
Mailing Address - Phone:225-925-5611
Mailing Address - Fax:225-925-5774
Practice Address - Street 1:1713 WOODDALE BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1570
Practice Address - Country:US
Practice Address - Phone:225-925-5611
Practice Address - Fax:225-925-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care