1033286356 NPI number — COMMUNITY-BASED SERVICES & CONSULTING GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033286356 NPI number — COMMUNITY-BASED SERVICES & CONSULTING GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY-BASED SERVICES & CONSULTING GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033286356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16083 SW 22ND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34481-8729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-465-3551
Provider Business Mailing Address Fax Number:
352-465-3549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20491 THE GRANADA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNNELLON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34432-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-465-3551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STANDRIDGE
Authorized Official First Name:
RICKEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
352-465-3551

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 686171798 . This is a "PROVIDER ID NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 686171796 . This is a "PROVIDER ID NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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