Provider Demographics
NPI:1093712754
Name:COMMUNITY CARE CENTER INC
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ESAU
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:MCMORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CM
Authorized Official - Phone:252-208-1928
Mailing Address - Street 1:PO BOX 3392
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-3392
Mailing Address - Country:US
Mailing Address - Phone:252-208-1928
Mailing Address - Fax:252-559-2055
Practice Address - Street 1:110 S QUEEN ST
Practice Address - Street 2:110 SOUTH QUEEN STREET SUITE 118
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4975
Practice Address - Country:US
Practice Address - Phone:252-208-1928
Practice Address - Fax:252-559-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA00000X101YA0400X
NC8700395302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111780Medicaid
NY8700395Medicaid