MEDICARE: COMMUNITY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	220602	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114070661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04402-0936
Country	:	US
Telephone Number	:	207-945-4240
Fax Number	:	207-990-3660

Provider Business Practice Location Address
First Line	:	40 SUMMER ST
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-6446
Country	:	US
Telephone Number	:	207-945-4240
Fax Number	:	207-990-3660

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	MS. NELLIE A KENNEDY
Credential	:
Telephone Number	:	207-945-4240

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	12/04/2013

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Directions to “COMMUNITY CARE ” Practice Location

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