NPIMap

Organization Active NPI

Community Support Network

  • Mental Illness Community Based Residential Treatment Facility
  • Santa Rosa, CA
National Provider Identifier
1427272004
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
496801902 Issued in CA
Legal business name
COMMUNITY SUPPORT NETWORK
Practice address
112 Brown St
Santa Rosa, CA 95404-5007
Phone
(707) 568-5204
Fax
(707) 575-3315
NPI assigned
Apr 13, 2007
Organization subpart
Yes
Parent organization
COMMUNITY SUPPORT NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Ms. Rosemary Devitt
Title
Director of Finance
Phone
(707) 575-0979

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 496801902 CA Primary

Addresses

Primary practice location

112 Brown St
Santa Rosa, CA 95404-5007

Mailing address

1410 Guerneville Rd
Suite 14
Santa Rosa, CA 95403-7231
Phone (707) 575-0979

Other names 1

  • CSN Brown St. Doing business as

National Provider Directory

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

Other organizations with this tax ID 8

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

Locations

112 Brown St
Santa Rosa, CA 95404
Phone (707) 568-5204

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1427272004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 GUERNEVILLE RD",
            "address_2": "SUITE 14",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954037231",
            "telephone_number": "707-575-0979",
            "fax_number": "707-573-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 BROWN ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045007",
            "telephone_number": "707-568-5204",
            "fax_number": "707-575-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY SUPPORT NETWORK",
        "enumeration_date": "2007-04-13",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "DEVITT",
        "authorized_official_first_name": "ROSEMARY",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "707-575-0979",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "496801902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CSN Brown St.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.