Provider Demographics
NPI:1669654091
Name:COMMUNITY CARE
Entity Type:Organization
Organization Name:COMMUNITY CARE
Other - Org Name:CCHAP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-462-3041
Mailing Address - Street 1:14644B LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-9290
Mailing Address - Country:US
Mailing Address - Phone:707-995-1606
Mailing Address - Fax:707-995-0309
Practice Address - Street 1:14644B LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9290
Practice Address - Country:US
Practice Address - Phone:707-995-1606
Practice Address - Fax:707-995-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7975326Medicaid