Provider Demographics
NPI:1215102728
Name:COMMUNITY SUPPORT SYSTEMS, INC.
Entity type:Organization
Organization Name:COMMUNITY SUPPORT SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:218-444-6748
Mailing Address - Street 1:PO BOX 1097
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-1097
Mailing Address - Country:US
Mailing Address - Phone:218-444-6748
Mailing Address - Fax:218-444-8664
Practice Address - Street 1:2014 7TH ST SE
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5051
Practice Address - Country:US
Practice Address - Phone:218-444-6748
Practice Address - Fax:218-444-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7H034COOtherBLUE CROSS/BLUE SHIELD
MN85D48HOOtherBLUE CROSS/BLUE SHIELD
MN7H034COOtherBLUE CROSS/BLUE SHIELD