Provider Demographics
NPI:1063848109
Name:COMMUNITY CARE NETWORK, INC
Entity Type:Organization
Organization Name:COMMUNITY CARE NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-947-6113
Mailing Address - Street 1:1500 S LAKE PARK AVE
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6638
Mailing Address - Country:US
Mailing Address - Phone:219-947-6113
Mailing Address - Fax:219-947-6503
Practice Address - Street 1:10607 RANDOLPH ST
Practice Address - Street 2:SUITE E
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7504
Practice Address - Country:US
Practice Address - Phone:219-947-6780
Practice Address - Fax:219-947-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty