Provider Demographics
NPI:1265671754
Name:COMMUNITY CARE CLINIC LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER- CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BAMBURG
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-397-3636
Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2069
Mailing Address - Country:US
Mailing Address - Phone:318-397-3636
Mailing Address - Fax:318-397-3639
Practice Address - Street 1:5328 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7506
Practice Address - Country:US
Practice Address - Phone:318-397-3636
Practice Address - Fax:318-397-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN97721APO5017261QP2300X
LARN073699APO3572261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care