MEDICARE: COMMUNITY CARE SYSTEMS ADULT DAY 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
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1972925402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE SYSTEMS ADULT DAY SERVICES, INC.

Provider Business Mailing Address
First Line	:	405 N MACARTHUR BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-2312
Country	:	US
Telephone Number	:	217-698-0200
Fax Number	:	217-698-9862

Provider Business Practice Location Address
First Line	:	639 YORK ST
Second Line	:	SUITE 110
City	:	QUINCY
State	:	IL
Zip	:	62301-3963
Country	:	US
Telephone Number	:	217-592-3757
Fax Number	:	217-223-6958

Authorized Official
Title or Position	:	CEO
Name	:	FRANK J VALA
Credential	:
Telephone Number	:	217-698-0200

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	10/26/2016

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