Healthcare Provider Details

I. General information

NPI: 1154856474
Provider Name (Legal Business Name): COMMUNITY CARE PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12035 N SAGUARO BLVD STE 203
FOUNTAIN HILLS AZ
85268
US

IV. Provider business mailing address

12035 N SAGUARO BLVD STE 203
FOUNTAIN HILLS AZ
85268-4647
US

V. Phone/Fax

Practice location:
  • Phone: 623-256-3986
  • Fax:
Mailing address:
  • Phone: 480-462-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLI L CASADY
Title or Position: MEMBER
Credential:
Phone: 480-462-2950