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General NPI Number Information
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NPI Number | 1265844450
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE SYSTEMS, INC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 3600 E STATE ST SUIITE 328
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City | ROCKFORD
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State | IL
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Zip | 61108-1978
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Country | US
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Telephone | 815-397-0410
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Fax | 815-397-0330
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Provider Business Mailing Address
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Address Line | 405 N MACARTHUR BLVD
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City | SPRINGFIELD
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State | IL
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Zip | 62702-2312
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Country | US
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Telephone | 217-698-0200
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Fax | 217-698-9862
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Authorized Official
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Title or Position | CEO
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Name | MR. FRANK J. VALA
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Credential |
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Telephone | 217-698-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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