Provider Demographics
NPI:1568287928
Name:COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DATA ANALYTICS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:MIHELIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-354-4547
Mailing Address - Street 1:9021 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2040
Mailing Address - Country:US
Mailing Address - Phone:708-354-4785
Mailing Address - Fax:
Practice Address - Street 1:9021 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-2040
Practice Address - Country:US
Practice Address - Phone:708-354-4785
Practice Address - Fax:708-354-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health