Basic Information
| Provider Information | |||||||||
| NPI: | 1982088274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY CARE SERVICES, LLS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8843756 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759824590 | ||||||||
| FaxNumber: | 7759824595 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E 2ND ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759822400 | ||||||||
| FaxNumber: | 7759822888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | BECK | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7759826488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.