MEDICARE: COMMUNITY CARE INC.

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1336584705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE INC.

Provider Business Mailing Address
First Line	:	3443 RTE 9 STE 9
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-9153
Country	:	US
Telephone Number	:	732-987-5038
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E COUNTY LINE RD STE 4
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1405
Country	:	US
Telephone Number	:	732-987-5038
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARTIN COLEMAN
Credential	:
Telephone Number	:	732-987-5038

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/30/2013

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