Community Support Specialists LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

COMMUNITY SUPPORT SPECIALISTS LLC

Practice address

85 Mantua Blvd
Mantua, NJ 08051-1448

Phone

(856) 472-2713

NPI assigned

Jan 18, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Derek Clark

Title

Owner

Phone

(856) 472-2713

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516233600000",
    "number": "1437667995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 MANTUA BLVD",
            "city": "MANTUA",
            "state": "NJ",
            "postal_code": "080511448",
            "telephone_number": "856-472-2713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 MANTUA BLVD",
            "city": "MANTUA",
            "state": "NJ",
            "postal_code": "080511448",
            "telephone_number": "856-472-2713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-472-2713",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Mantua, NJ
• Case Manager/Care Coordinator in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2018; 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.