MEDICARE: COMMUNITY CARE SYSTEMS, 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	253Z00000X	In Home Supportive Care Agency

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

General Provider Information

NPI Number	:	1831501022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	405 N MACARTHUR BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-2312
Country	:	US
Telephone Number	:	217-698-0200
Fax Number	:	217-698-9862

Provider Business Practice Location Address
First Line	:	639 YORK ST
Second Line	:	112
City	:	QUINCY
State	:	IL
Zip	:	62301-3963
Country	:	US
Telephone Number	:	217-223-6951
Fax Number	:	217-223-6958

Authorized Official
Title or Position	:	CEO
Name	:	MR. FRANK J VALA
Credential	:
Telephone Number	:	217-698-0200

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	10/26/2016

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