Provider Demographics
NPI:1437380516
Name:CARROLLS COMMUNITY CARE
Entity Type:Organization
Organization Name:CARROLLS COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NICOL
Authorized Official - Last Name:FURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-442-8893
Mailing Address - Street 1:523 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-442-8893
Mailing Address - Fax:619-442-6049
Practice Address - Street 1:523 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5005
Practice Address - Country:US
Practice Address - Phone:619-442-8893
Practice Address - Fax:619-442-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health