Provider Demographics
NPI:1396505004
Name:CHILDREN GUIDANCE SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:CHILDREN GUIDANCE SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAANATHSHILOH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-752-8334
Mailing Address - Street 1:1710 60TH ST UPPR
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3957
Mailing Address - Country:US
Mailing Address - Phone:262-705-1837
Mailing Address - Fax:
Practice Address - Street 1:1710 60TH ST UPPR
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3957
Practice Address - Country:US
Practice Address - Phone:262-752-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385H00000XRespite Care FacilityRespite Care