NPIMap

Organization Active NPI

Community Support Professionals,LLC

  • Community/Behavioral Health Agency
  • Wilmington, NC
National Provider Identifier
1659676377
Registry record updated Jan 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
3410026 Issued in NC
Legal business name
COMMUNITY SUPPORT PROFESSIONALS,LLC
Practice address
1606 Wellington Ave Unit C
Community Support Professionals,LLC
Wilmington, NC 28401-7704
Phone
(910) 799-4505
Fax
(910) 799-4345
NPI assigned
Jan 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2011

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

Authorized official

Name
Mr. Charles Creech
Title
C.E.O.
Phone
(910) 799-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 3410026 NC Primary

Addresses

Primary practice location

1606 Wellington Ave Unit C
Community Support Professionals,LLC
Wilmington, NC 28401-7704

Mailing address

1606 Wellington Ave Unit C
Community Support Professionals,LLC
Wilmington, NC 28401-7704
Phone (910) 799-4505

Other identifiers 1

IdentifierTypeStateIssuer
3410026MedicaidNC

Other names 1

  • Targeted Case Managment: TCM-MH/SA Other name

National Provider Directory

National Provider Directory
Tax ID family
Community Support Professionalsllc9 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": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1659676377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "address_2": "COMMUNITY SUPPORT PROFESSIONALS,LLC",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017704",
            "telephone_number": "910-799-4505",
            "fax_number": "910-799-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "address_2": "COMMUNITY SUPPORT PROFESSIONALS,LLC",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017704",
            "telephone_number": "910-799-4505",
            "fax_number": "910-799-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SUPPORT PROFESSIONALS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "CREECH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "910-799-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "3410026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410026",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Targeted Case Managment: TCM-MH/SA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; 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.