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General NPI Number Information
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NPI Number | 1679081525
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE MANAGEMENT SERVICES
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 505 CAMBRIDGE PLACE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2169
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Country | US
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Telephone | 501-813-0879
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Fax | 501-313-5355
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Provider Business Mailing Address
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Address Line | 505 CAMBRIDGE PLACE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2169
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Country | US
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Telephone | 501-813-0879
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Fax | 501-313-5355
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ROBERTA HENRY
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Credential | LPN, CPC, CPC-I
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Telephone | 501-813-0879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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