1033296363 NPI number — COMMUNITY CARE NETWORK INC

Table of content: (NPI 1033296363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033296363 NPI number — COMMUNITY CARE NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY CARE NETWORK 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:
COMMUNITY CARE PHARMACY
Provider Other Organization Name Type Code:
3
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:
1033296363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3167 FULTON RD
Provider Second Line Business Mailing Address:
STE. 111
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44109-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-283-3865
Provider Business Mailing Address Fax Number:
216-651-1590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3167 FULTON RD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-283-3865
Provider Business Practice Location Address Fax Number:
216-651-1590
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
216-283-3865

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 02154695003 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2586607 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2080327 . This is a "PK" identifier . This identifiers is of the category "OTHER".