Basic Information
| Provider Information | |||||||||
| NPI: | 1205959194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY CARE SERVICES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194013061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102722307 | ||||||||
| FaxNumber: | 6102721569 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 N TRYON ST | ||||||||
| Address2: | SUITE 321 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282062793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043328786 | ||||||||
| FaxNumber: | 7043328788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NIXON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | JEROME | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6102722307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | BBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.