Healthcare Provider Details

I. General information

NPI: 1013044643
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

13241 COUNTY HOME ROAD E23
SCOTCH GROVE IA
52310
US

IV. Provider business mailing address

108 INDUSTRIAL ST
DE WITT IA
52742-2063
US

V. Phone/Fax

Practice location:
  • Phone: 319-462-3875
  • Fax: 563-487-3623
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 Number530041
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02-45142
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

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