Provider Demographics
NPI:1699532200
Name:TRUE COMMUNITY SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:TRUE COMMUNITY SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF CILA
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:JEANA
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-741-6823
Mailing Address - Street 1:7008 MILLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6966
Mailing Address - Country:US
Mailing Address - Phone:618-741-6823
Mailing Address - Fax:
Practice Address - Street 1:7008 MILLBROOK LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-6966
Practice Address - Country:US
Practice Address - Phone:618-741-6823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities