Provider Demographics
NPI:1306006515
Name:COMMUNITY CARE SERVICES INC
Entity Type:Organization
Organization Name:COMMUNITY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:662-332-0911
Mailing Address - Street 1:228 DR MARTIN LUTHER KING BLVD S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4303
Mailing Address - Country:US
Mailing Address - Phone:662-332-0911
Mailing Address - Fax:662-332-0911
Practice Address - Street 1:228 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4303
Practice Address - Country:US
Practice Address - Phone:662-332-0911
Practice Address - Fax:662-332-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS76C3PFA5142261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care