MEDICARE: COMMUNITY CARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	101YA00000X	NC
2	302R00000X	Health Maintenance Organization	8700395	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093712754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 3392
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28502-3392
Country	:	US
Telephone Number	:	252-208-1928
Fax Number	:	252-559-2055

Provider Business Practice Location Address
First Line	:	110 S QUEEN ST
Second Line	:	110 SOUTH QUEEN STREET SUITE 118
City	:	KINSTON
State	:	NC
Zip	:	28501-4975
Country	:	US
Telephone Number	:	252-208-1928
Fax Number	:	252-559-2055

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ESAU ARNOLD MCMORRIS
Credential	:	C.M.
Telephone Number	:	252-208-1928

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/11/2025

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Directions to “COMMUNITY CARE CENTER INC ” Practice Location

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