NPIMap

Organization Active NPI

Community Support Agency, LLC

  • Community/Behavioral Health Agency
  • Delco, NC
National Provider Identifier
1447393020
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COMMUNITY SUPPORT AGENCY, LLC
Practice address
44 Dream Ave
Delco, NC 28436-8700
Phone
(910) 297-4230
Fax
(910) 297-4230
NPI assigned
Feb 14, 2007
Last updated
Oct 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

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

Authorized official

Name
Mrs. Devoria Keaton BerryNPI 1942672761
Title
Executive Director
Phone
(910) 655-0698

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

44 Dream Ave
Delco, NC 28436-8700

Mailing address

P.O Box 465
Delco, NC 28436-9221
Phone (910) 655-0698

Other practice location 1

817B S Madison St
Whiteville, NC 28472-4613
Phone (910) 207-6761

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110216001043 NC Part B Supplier - Clinic/Group Practice 5294916730 Receives reassigned benefits from 2 practitioners
Practice locations: Delco, NC; Whiteville, NC

National Provider Directory

National Provider Directory

Locations

27001 Andrew Jackson Hwy E
Delco, NC 28436
Phone (910) 655-0611

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539648000000",
    "number": "1447393020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 465",
            "city": "DELCO",
            "state": "NC",
            "postal_code": "284369221",
            "telephone_number": "910-655-0698",
            "fax_number": "910-655-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 DREAM AVE",
            "city": "DELCO",
            "state": "NC",
            "postal_code": "284368700",
            "telephone_number": "910-297-4230",
            "fax_number": "910-297-4230"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817B S Madison St",
            "address_purpose": "LOCATION",
            "city": "Whiteville",
            "state": "NC",
            "postal_code": "284724613",
            "country_code": "US",
            "telephone_number": "910-207-6761",
            "fax_number": "910-207-6782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2018-10-16",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "DEVORIA",
        "authorized_official_middle_name": "KEATON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-655-0698",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delco, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.