Provider Demographics
NPI:1285168047
Name:COMMUNITY SUPPORTS NETWORK
Entity type:Organization
Organization Name:COMMUNITY SUPPORTS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-919-3211
Mailing Address - Street 1:49 PINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1463
Mailing Address - Country:US
Mailing Address - Phone:201-919-3211
Mailing Address - Fax:
Practice Address - Street 1:170 CHANGEBRIDGE RD BLDG A42
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9112
Practice Address - Country:US
Practice Address - Phone:201-919-3211
Practice Address - Fax:908-891-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services