Provider Demographics
NPI:1629384607
Name:COMMUNITY CARES CLINIC
Entity Type:Organization
Organization Name:COMMUNITY CARES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-756-1521
Mailing Address - Street 1:3100 SYCAMORE RD
Mailing Address - Street 2:SUITE 1024
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-752-3253
Mailing Address - Fax:
Practice Address - Street 1:3100 SYCAMORE RD
Practice Address - Street 2:SUITE 1024
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-752-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health