Basic Information
| Provider Information | |||||||||
| NPI: | 1265682975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY-BASED SERVICES LLC | ||||||||
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| OtherOrganizationName: | THE DIABETES EDUCATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 POWELL CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153728500 | ||||||||
| FaxNumber: | 6153728581 | ||||||||
| Practice Location | |||||||||
| Address1: | 2011 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246412305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769639577 | ||||||||
| FaxNumber: | 2769634747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2008 | ||||||||
| LastUpdateDate: | 09/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | DILL | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6153728500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.