Provider Demographics
NPI: | 1487125977 |
---|---|
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: | |
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: | 75 PRINGLE WAY STE 505 |
Practice Address - Street 2: | |
Practice Address - City: | RENO |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89502-1469 |
Practice Address - Country: | US |
Practice Address - Phone: | 775-982-5437 |
Practice Address - Fax: | 775-982-3895 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | COMMUNITY CARE SERVICES LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-12-10 |
Last Update Date: | 2025-04-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 133VN1004X | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | Group - Multi-Specialty |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 207SG0202X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Biochemical Genetics | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |