Healthcare Provider Details

I. General information

NPI: 1235403114
Provider Name (Legal Business Name): COMMUNITY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLIAMS ST
TAUNTON MA
02780-2711
US

IV. Provider business mailing address

100 WILLIAMS ST
TAUNTON MA
02780-2711
US

V. Phone/Fax

Practice location:
  • Phone: 508-822-2345
  • Fax: 508-822-5363
Mailing address:
  • Phone: 508-822-2345
  • Fax: 508-822-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberS17518236
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. DEREK MICHAEL GEORGE I
Title or Position: CASE MANAGER
Credential: BA
Phone: 508-822-2345