=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336584705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2013
-----------------------------------------------------
Last Update Date | 04/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 E COUNTY LINE RD STE 4
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-1405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-987-5038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3443 RTE 9 STE 9
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-9153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-987-5038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARTIN COLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-987-5038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------