Provider Demographics
NPI:1053677385
Name:COMMUNITY CHOICE CARE NETWORK INC
Entity Type:Organization
Organization Name:COMMUNITY CHOICE CARE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-3969
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:SUITE B- 213
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-539-3969
Mailing Address - Fax:877-424-7909
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE B- 213
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-539-3969
Practice Address - Fax:877-424-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based