Healthcare Provider Details

I. General information

NPI: 1578690244
Provider Name (Legal Business Name): COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 330TH AVE
CHARLOTTE IA
52731-9682
US

IV. Provider business mailing address

108 INDUSTRIAL ST
DE WITT IA
52742-2063
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-4100
  • Fax: 563-677-2312
Mailing address:
  • Phone: 563-659-4100
  • Fax: 563-659-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number230904
License Number StateIA

VIII. Authorized Official

Name: MR. BENJAMIN WRIGHT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 563-659-4100