Healthcare Provider Details

I. General information

NPI: 1720056732
Provider Name (Legal Business Name): COMMUNITY CONCEPTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17-19 MARKET SQUARE
SOUTH PARIS ME
04281-0278
US

IV. Provider business mailing address

17-19 MARKET SQUARE PO BOX 278
SOUTH PARIS ME
04281-0278
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7716
  • Fax: 207-743-6513
Mailing address:
  • Phone: 207-743-7716
  • Fax: 207-743-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-743-7716