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General NPI Number Information
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NPI Number | 1609287077
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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 | 05/19/2014
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 17475 JOVANNA DR UNIT 2A
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City | HOMEWOOD
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State | IL
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Zip | 60430-1020
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Country | US
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Telephone | 708-798-5996
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Fax | 708-798-7066
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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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