Provider Demographics
NPI:1417369224
Name:COMMUNITY CARE SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-698-0200
Mailing Address - Street 1:405 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2312
Mailing Address - Country:US
Mailing Address - Phone:217-698-0200
Mailing Address - Fax:217-698-9862
Practice Address - Street 1:200 WESTGATE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2020
Practice Address - Country:US
Practice Address - Phone:618-548-1613
Practice Address - Fax:618-548-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL930Medicaid