NPIMap

Organization Active NPI

Community Support Network

  • Mental Illness Community Based Residential Treatment Facility
  • Petaluma, CA
National Provider Identifier
1396954087
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
COMMUNITY SUPPORT NETWORK
Practice address
21 Faye CT
Petaluma, CA 94952-2202
Phone
(707) 765-0102
Fax
(707) 765-0124
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Allison Ball
Title
Program Manager
Phone
(707) 765-0102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X CA Primary

Addresses

Primary practice location

21 Faye CT
Petaluma, CA 94952-2202

Mailing address

21 Faye CT
Petaluma, CA 94952-2202
Phone (707) 765-0102

National Provider Directory

National Provider Directory
Tax ID family
CSN- Bridges9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396954087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 FAYE CT",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522202",
            "telephone_number": "707-765-0102",
            "fax_number": "707-765-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 FAYE CT",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522202",
            "telephone_number": "707-765-0102",
            "fax_number": "707-765-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "707-765-0102",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.