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NPI Code Detail

MEDICARE: COMMUNITY CLINICAL SERVICES, INC

MEDICARE: COMMUNITY CLINICAL SERVICES, 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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1629851761
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY CLINICAL SERVICES, INC
Provider Business Mailing Address
First Line : 57 BIRCH ST STE 201
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7415
Country : US
Telephone Number : 207-513-3897
Fax Number : 207-330-9515
Provider Business Practice Location Address
First Line : 103 PARK ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7203
Country : US
Telephone Number : 207-753-5400
Fax Number : 207-786-0489
Authorized Official
Title or Position : CEO
Name : COLEEN L ELIAS
Credential :
Telephone Number : 207-513-3897
Provider Enumeration Date : 08/14/2023
Last Update Date : 04/05/2024

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