Provider Demographics
NPI:1023169703
Name:COMMUNITY CARE ASSOCIATES
Entity type:Organization
Organization Name:COMMUNITY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PELAK-REGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-999-7603
Mailing Address - Street 1:300 RIVER PLACE DR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4457
Mailing Address - Country:US
Mailing Address - Phone:313-999-7603
Mailing Address - Fax:313-656-6008
Practice Address - Street 1:300 RIVER PLACE DR
Practice Address - Street 2:SUITE 2500
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4457
Practice Address - Country:US
Practice Address - Phone:313-999-7603
Practice Address - Fax:313-656-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization