Healthcare Provider Details

I. General information

NPI: 1184702821
Provider Name (Legal Business Name): COMMUNITY CLINICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BIRCH ST STE 102
LEWISTON ME
04240-7415
US

IV. Provider business mailing address

PO BOX 95000 LBX 7660
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-5400
  • Fax: 207-786-0489
Mailing address:
  • Phone: 207-777-8202
  • Fax: 207-783-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: COLEEN L ELIAS
Title or Position: CEO/CFO
Credential:
Phone: 207-513-3897