Provider Demographics
NPI:1033247085
Name:COMMUNITY COMMONS
Entity Type:Organization
Organization Name:COMMUNITY COMMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-394-3037
Mailing Address - Street 1:1340 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2084
Mailing Address - Country:US
Mailing Address - Phone:330-394-3037
Mailing Address - Fax:330-395-0017
Practice Address - Street 1:1340 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2084
Practice Address - Country:US
Practice Address - Phone:330-394-3037
Practice Address - Fax:330-395-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6361310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2677410Medicaid