Provider Demographics
NPI:1891510996
Name:CALIFORNIA SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:CALIFORNIA SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:925-209-1648
Mailing Address - Street 1:5222 COSUMNES DR APT 41
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7208
Mailing Address - Country:US
Mailing Address - Phone:925-209-1648
Mailing Address - Fax:
Practice Address - Street 1:1001 STONEMAN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5479
Practice Address - Country:US
Practice Address - Phone:925-209-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management