Provider Demographics
NPI:1053945659
Name:COMMUNITY SOCIAL INTEGRATION, LLC
Entity type:Organization
Organization Name:COMMUNITY SOCIAL INTEGRATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-980-5479
Mailing Address - Street 1:2666 STATE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2232
Mailing Address - Country:US
Mailing Address - Phone:203-287-1543
Mailing Address - Fax:203-407-1625
Practice Address - Street 1:2666 STATE ST STE 6
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2232
Practice Address - Country:US
Practice Address - Phone:203-287-1543
Practice Address - Fax:203-407-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212605AMedicaid
GA003212605BMedicaid