Healthcare Provider Details

I. General information

NPI: 1871650085
Provider Name (Legal Business Name): COMMUNITY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BISHOPS WAY
BROOKFIELD WI
53005-6247
US

IV. Provider business mailing address

205 BISHOPS WAY
BROOKFIELD WI
53005-6247
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-4000
  • Fax: 262-827-7051
Mailing address:
  • Phone: 414-231-4000
  • Fax: 262-827-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GARLIE IX
Title or Position: CORPORATE COMPLIANCE OFFICER
Credential:
Phone: 262-207-9370