Provider Demographics
NPI:1912749540
Name:COMMUNITY THERAPY CENTERS CORP
Entity type:Organization
Organization Name:COMMUNITY THERAPY CENTERS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-172-4589
Mailing Address - Street 1:115 MAIN ST S STE D
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1940
Mailing Address - Country:US
Mailing Address - Phone:931-217-2458
Mailing Address - Fax:
Practice Address - Street 1:115 MAIN ST S STE D
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1940
Practice Address - Country:US
Practice Address - Phone:931-217-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp