Provider Demographics
NPI:1376628537
Name:COMMUNITY CORRECTIONAL ALTERNATIVES, INC.
Entity Type:Organization
Organization Name:COMMUNITY CORRECTIONAL ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-872-4500
Mailing Address - Street 1:15 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6104
Mailing Address - Country:US
Mailing Address - Phone:207-872-4500
Mailing Address - Fax:207-872-2441
Practice Address - Street 1:15 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6104
Practice Address - Country:US
Practice Address - Phone:207-872-4500
Practice Address - Fax:207-872-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME414950251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME170230000Medicaid
ME=========OtherTAX ID #