Healthcare Provider Details

I. General information

NPI: 1689710535
Provider Name (Legal Business Name): COMMUNITY CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 MOUNTAIN AVE
DUARTE CA
91010-3559
US

IV. Provider business mailing address

2335 MOUNTAIN AVE
DUARTE CA
91010-3559
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-3207
  • Fax: 626-303-1116
Mailing address:
  • Phone: 626-357-3207
  • Fax: 626-303-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: PETER BENNETT
Title or Position: PRESIDENT
Credential:
Phone: 626-357-3207