NPIMap

Organization Active NPI

Community Support Professionals,LLC

  • In Home Supportive Care Agency
  • Wilmington, NC
National Provider Identifier
1831428119
Registry record updated Dec 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
8300728H Issued in NC
Legal business name
COMMUNITY SUPPORT PROFESSIONALS,LLC
Practice address
1606 Wellington Ave Unit C
Wilmington, NC 28401-7704
Phone
(910) 799-4505
Fax
(910) 799-4345
NPI assigned
Dec 15, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2009

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

Authorized official

Name
Mr. Martin Justafort
Title
Operations Manager
Phone
(910) 799-4345

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 8300728H NC Primary

Addresses

Primary practice location

1606 Wellington Ave Unit C
Wilmington, NC 28401-7704

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
8300728HMedicaidNC

Other names 1

  • CSP Intensive In Home 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.

Locations

1606 Wellington Ave
Ste C
Wilmington, NC 28401
Phone (910) 799-4505

NPI Registry JSON

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

{
    "created_epoch": "1260835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260835200000",
    "number": "1831428119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "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",
            "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": "2009-12-15",
        "last_updated": "2009-12-15",
        "status": "A",
        "authorized_official_last_name": "JUSTAFORT",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "910-799-4345",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "8300728H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300728H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CSP Intensive In Home",
            "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 Dec 15, 2009; 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.