Provider Demographics
NPI:1942174586
Name:COMMUNITYCARE MEDICARE LLC
Entity type:Organization
Organization Name:COMMUNITYCARE MEDICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JATANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-761-1241
Mailing Address - Street 1:7734 MADISON BLVD STE 126
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2385
Mailing Address - Country:US
Mailing Address - Phone:256-762-1241
Mailing Address - Fax:
Practice Address - Street 1:7734 MADISON BLVD STE 126
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2385
Practice Address - Country:US
Practice Address - Phone:256-762-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty