Provider Demographics
NPI:1154479822
Name:COMMUNITY CARE HEALTH PLAN, INC
Entity Type:Organization
Organization Name:COMMUNITY CARE HEALTH PLAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGULATORY AFFAIRS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-207-9362
Mailing Address - Street 1:205 BISHOPS WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6247
Mailing Address - Country:US
Mailing Address - Phone:414-231-4000
Mailing Address - Fax:262-827-7051
Practice Address - Street 1:205 BISHOPS WAY
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6247
Practice Address - Country:US
Practice Address - Phone:414-231-4000
Practice Address - Fax:262-827-7051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251T00000X, 261QA0600X
WI302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care