Provider Demographics
NPI:1629851761
Name:COMMUNITY CLINICAL SERVICES, INC
Entity Type:Organization
Organization Name:COMMUNITY CLINICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-513-3897
Mailing Address - Street 1:57 BIRCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7415
Mailing Address - Country:US
Mailing Address - Phone:207-513-3897
Mailing Address - Fax:207-330-9515
Practice Address - Street 1:103 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7203
Practice Address - Country:US
Practice Address - Phone:207-753-5400
Practice Address - Fax:207-786-0489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CLINIC SERVICE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)