Provider Demographics
NPI:1629340690
Name:CC CARE LLC
Entity Type:Organization
Organization Name:CC CARE LLC
Other - Org Name:COMMUNITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-501-0996
Mailing Address - Street 1:4314 S WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3119
Mailing Address - Country:US
Mailing Address - Phone:773-538-8300
Mailing Address - Fax:773-538-5775
Practice Address - Street 1:4314 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3119
Practice Address - Country:US
Practice Address - Phone:773-538-8300
Practice Address - Fax:773-538-5775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JLM FINANCIAL HEALTHCARE, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-06
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0051722Medicaid