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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