1598811911 NPI number — COMMUNITY CARE INC

Table of content: (NPI 1598811911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598811911 NPI number — COMMUNITY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY CARE 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:
1598811911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-987-5038
Provider Business Mailing Address Fax Number:
732-987-5041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 US HIGHWAY 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-9153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-462-5553
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
732-634-3331

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  910100105 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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