Organization
COMMUNITY INTEGRATION SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM PAUL (PRESIDENT)
(317) 201-5090
Entity
Organization
Contact information
Practice address
7560 OLD TRAILS RD, INDIANAPOLIS, IN 46219-6743
(317) 429-9885
Mailing address
7560 OLD TRAILS RD, INDIANAPOLIS, IN 46219-6743
(317) 429-9885
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201267110A
—
IN
Enumeration date
01/16/2015
Last updated
01/16/2015
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