Provider Demographics
NPI:1073161303
Name:COMMUNITY CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE, INC.
Other - Org Name:PRIVATE DUTY NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WASIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPAC
Authorized Official - Phone:724-830-9918
Mailing Address - Street 1:201 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-2700
Mailing Address - Country:US
Mailing Address - Phone:724-830-9918
Mailing Address - Fax:724-830-9919
Practice Address - Street 1:201 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672-2700
Practice Address - Country:US
Practice Address - Phone:724-830-9918
Practice Address - Fax:724-830-9919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-29
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007547000014Medicaid