Healthcare Provider Details

I. General information

NPI: 1770054397
Provider Name (Legal Business Name): COMMUNITY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 DOUBLE R BLVD STE 205
RENO NV
89521-3854
US

IV. Provider business mailing address

1155 MILL ST # M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5000
  • Fax: 775-982-8001
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRETT MOORE
Title or Position: CFO ACUTE CARE
Credential:
Phone: 775-982-6343