Organization
COMMUNITY INTEGRATION SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL ALLAN BURNS JR. (AO)
(330) 503-2224
Entity
Organization
Contact information
Practice address
635 CARSON SALT SPRINGS RD, MINERAL RIDGE, OH 44440-9334
(330) 503-2224
Mailing address
635 CARSON SALT SPRINGS RD, MINERAL RIDGE, OH 44440-9334
(330) 503-2224
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
376J00000X
Homemaker
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
09/07/2023
Last updated
09/13/2023
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