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Organization

COMMUNITY SUPPORT SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE FARINA WHITE (PRESIDENT AND CEO)
(708) 354-4547
Entity
Organization

Contact information

Practice address
9021 OGDEN AVENUE, BROOKFIELD, IL 60513
(708) 354-4547
(708) 354-7412
Mailing address
9021 OGDEN AVE, BROOKFIELD, IL 60513
(708) 354-4547
(708) 354-7412

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
150010241
IL
104100000X
Social Worker
Primary
178005304
IL
251B00000X
Case Management Agency
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
199400214C
IL

Other

Enumeration date
10/12/2006
Last updated
11/12/2015
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