Provider Demographics
NPI:1194073304
Name:CONSUMER SUPPORT NETWORK, LTD. CO.
Entity type:Organization
Organization Name:CONSUMER SUPPORT NETWORK, LTD. CO.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN FRANCOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:305-981-0300
Mailing Address - Street 1:2449 SW GAMBERI ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2711
Mailing Address - Country:US
Mailing Address - Phone:305-981-0300
Mailing Address - Fax:305-981-0500
Practice Address - Street 1:1175 NE 125TH ST
Practice Address - Street 2:STE 413
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5015
Practice Address - Country:US
Practice Address - Phone:305-981-0300
Practice Address - Fax:305-981-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251S00000X, 251X00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687468198Medicaid
FL678751796Medicaid
FL678751702Medicaid
FL687440179Medicaid