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NPI Code Detail

MEDICARE: MR. JERRY RICHARD MCCANN

MEDICARE: MR. JERRY RICHARD MCCANN
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1134271778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JERRY RICHARD MCCANN
Provider Business Mailing Address
First Line : 2001 THE ALAMEDA
Second Line : ALLIANCE FOR COMMUNITY CARE
City : SAN JOSE
State : CA
Zip : 95126-1136
Country : US
Telephone Number : 408-261-7777
Fax Number : 408-254-9960
Provider Business Practice Location Address
First Line : 86 S 14TH ST
Second Line : ALLIANCE FOR COMMUNITY CARE INTENSIVE SERVICES PROGRAM
City : SAN JOSE
State : CA
Zip : 95112-2015
Country : US
Telephone Number : 408-938-6750
Fax Number : 408-977-0145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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Directions to “ MR. JERRY RICHARD MCCANN ” Practice Location

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