Provider Demographics
NPI:1053038950
Name:COMMUNITY SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-712-3920
Mailing Address - Street 1:3707 W GOOD HOPE RD APT 7
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2362
Mailing Address - Country:US
Mailing Address - Phone:414-712-3920
Mailing Address - Fax:
Practice Address - Street 1:3707 W GOOD HOPE RD APT 7
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2362
Practice Address - Country:US
Practice Address - Phone:414-712-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)