1760774392 NPI number — COMMUNITY CLINICAL SERVICES, INC.

Table of content: (NPI 1760774392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760774392 NPI number — COMMUNITY CLINICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY CLINICAL SERVICES, 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:
6
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:
1760774392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000 LBX 7660
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-8202
Provider Business Mailing Address Fax Number:
707-783-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04210-4671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-782-6827
Provider Business Practice Location Address Fax Number:
207-376-0090
Provider Enumeration Date:
05/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ELIAS
Authorized Official First Name:
COLEEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO/CFO
Authorized Official Telephone Number:
207-513-3897

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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