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	3336L0003X	Long Term Care Pharmacy
2	3336M0003X	Managed Care Organization Pharmacy	8638-42	WI

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	2110889	OTHER		PK

General Provider Information

NPI Number	:	1932213923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE INC

Provider Business Mailing Address
First Line	:	1555 S LAYTON BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1924
Country	:	US
Telephone Number	:	414-902-2397
Fax Number	:	414-649-9149

Provider Business Practice Location Address
First Line	:	1555 S LAYTON BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-1924
Country	:	US
Telephone Number	:	414-902-2397
Fax Number	:	414-649-9149

Authorized Official
Title or Position	:	CEO
Name	:	MR. KENNETH MUNSON
Credential	:
Telephone Number	:	414-231-4000

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/24/2019

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Directions to “COMMUNITY CARE INC ” Practice Location

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