Provider Demographics
NPI:1265735674
Name:CANCER CARE PARTNERS, LLC
Entity type:Organization
Organization Name:CANCER CARE PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:574-204-7300
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46624-0539
Mailing Address - Country:US
Mailing Address - Phone:574-204-7300
Mailing Address - Fax:574-204-7301
Practice Address - Street 1:301 E DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3455
Practice Address - Country:US
Practice Address - Phone:574-204-7300
Practice Address - Fax:574-204-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN282N00000X
IN110123871284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No282N00000XHospitalsGeneral Acute Care Hospital