MEDICARE: COMMUNITY CARE NETWORKS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952982225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE NETWORKS

Provider Business Mailing Address
First Line	:	7340 HERITAGE VILLAGE PLZ STE 101
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 HERITAGE VILLAGE PLZ STE 101
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	571-284-6129
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	PAMELA LUCAS
Credential	:
Telephone Number	:	571-284-6129

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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Directions to “COMMUNITY CARE NETWORKS ” Practice Location

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