MEDICARE: COMMUNITY CARE CLINIC LLC

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	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1851243810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE CLINIC LLC

Provider Business Mailing Address
First Line	:	3065 W BANCROFT ST STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3353
Country	:	US
Telephone Number	:	419-340-0240
Fax Number	:

Provider Business Practice Location Address
First Line	:	3065 W BANCROFT ST STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-3353
Country	:	US
Telephone Number	:	419-340-0240
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF ENTITY
Name	:	MOHAMAD MOUSSA
Credential	:	MD
Telephone Number	:	419-344-8669

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	03/23/2026

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