Provider Demographics
NPI: | 1720031768 |
---|---|
Name: | COMMUNITY CARE SERVICES LLC |
Entity type: | Organization |
Organization Name: | COMMUNITY CARE SERVICES LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO ACUTE CARE |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRETT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MOORE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 775-982-6343 |
Mailing Address - Street 1: | 1155 MILL ST # M14 |
Mailing Address - Street 2: | |
Mailing Address - City: | RENO |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89502-1576 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 775-982-5262 |
Mailing Address - Fax: | 775-982-5496 |
Practice Address - Street 1: | 1155 MILL ST |
Practice Address - Street 2: | |
Practice Address - City: | RENO |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89502-1576 |
Practice Address - Country: | US |
Practice Address - Phone: | 775-982-5000 |
Practice Address - Fax: | 775-982-4196 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HOMETOWN HEALTH MANAGEMENT COMPANY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-19 |
Last Update Date: | 2025-04-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 1720031768 | Medicaid | |
DE5373 | Other | RR MEDICARE PTAN | |
V109390 | Medicare PIN | ||
NV | V109389 | Medicare PIN | |
NV | V101879 | Medicare PIN | |
NV | 1720031768 | Medicaid | |
CA | CA149522 | Medicare PIN |