Provider Demographics
NPI:1831374370
Name:COMMUNITY SUPPORT SPECIALISTS, INC
Entity type:Organization
Organization Name:COMMUNITY SUPPORT SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-245-5757
Mailing Address - Street 1:PO BOX 870462
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70187-0462
Mailing Address - Country:US
Mailing Address - Phone:504-245-5757
Mailing Address - Fax:866-902-2182
Practice Address - Street 1:7921 BULLARD AVE
Practice Address - Street 2:UNIT 2B
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1197
Practice Address - Country:US
Practice Address - Phone:504-245-5757
Practice Address - Fax:866-902-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11947251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431664Medicaid