Provider Demographics
NPI:1386869246
Name:COMMUNITY SUPPORT NETWORK
Entity type:Organization
Organization Name:COMMUNITY SUPPORT NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-575-0979
Mailing Address - Street 1:1410 GUERNEVILLE RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403
Mailing Address - Country:US
Mailing Address - Phone:707-575-0979
Mailing Address - Fax:707-573-6968
Practice Address - Street 1:201 S. E ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-573-6968
Practice Address - Fax:707-569-8358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY SUPPORT NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-16
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490111571320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA490111571OtherCCL NUMBER