Provider Demographics
NPI:1073544805
Name:COMMUNITY CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
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:15672-9756
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:15672-9756
Practice Address - Country:US
Practice Address - Phone:724-830-9918
Practice Address - Fax:724-830-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02510501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007547000002Medicaid
PA398028Medicare ID - Type Unspecified