Provider Demographics
NPI:1417713363
Name:COGNITIVE COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:COGNITIVE COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-329-3292
Mailing Address - Street 1:36 BEAUFORT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4624
Mailing Address - Country:US
Mailing Address - Phone:207-329-3292
Mailing Address - Fax:
Practice Address - Street 1:415 CONGRESS ST STE 408
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3500
Practice Address - Country:US
Practice Address - Phone:207-329-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health