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Organization
COMMUNITY SUPPORT PROFESSIONALS,LLC
Active
Organization
COMMUNITY SUPPORT PROFESSIONALS,LLC
Active
Other names
CSP Intensive In Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN JUSTAFORT (OPERATIONS MANAGER)
(910) 799-4345
Entity
Organization
Contact information
Practice address
1606 WELLINGTON AVE UNIT C, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Mailing address
1606 WELLINGTON AVE UNIT C, WILMINGTON, NC 28401-7704
(910) 799-4505
(910) 799-4345
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
8300728H
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300728H
—
NC
Enumeration date
12/15/2009
Last updated
12/15/2009
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