Provider Demographics
NPI:1407207509
Name:COMMUNITY CARE GROUP LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE GROUP LLC
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAASBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-639-5949
Mailing Address - Street 1:25090 JEFFERSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1704
Mailing Address - Country:US
Mailing Address - Phone:951-639-5949
Mailing Address - Fax:
Practice Address - Street 1:25090 JEFFERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1704
Practice Address - Country:US
Practice Address - Phone:951-639-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHCO# 334700056253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care