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General NPI Number Information
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NPI Number | 1467714618
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE CENTER CORPORATION
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 11/23/2012
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Provider Practice Location Address
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Address Line | 1216 E BALTIMORE ST ATTN: COMMUNITY CARE CENTER
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City | BALTIMORE
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State | MD
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Zip | 21202-4710
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Country | US
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Telephone | 410-870-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 E BALTIMORE ST ATTN: COMMUNITY CARE CENTER
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City | BALTIMORE
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State | MD
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Zip | 21202-4710
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Country | US
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Telephone | 410-870-5483
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MR. MICHAEL M ROGERS
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Credential |
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Telephone | 410-870-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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