Provider Demographics
NPI:1053197798
Name:COMMUNITY INTEGRATION SUPPORTS
Entity type:Organization
Organization Name:COMMUNITY INTEGRATION SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:330-503-2224
Mailing Address - Street 1:635 CARSON SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9334
Mailing Address - Country:US
Mailing Address - Phone:330-503-2224
Mailing Address - Fax:
Practice Address - Street 1:635 CARSON SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9334
Practice Address - Country:US
Practice Address - Phone:330-503-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty