Provider Demographics
NPI:1689710535
Name:COMMUNITY CARE CENTER INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-357-3207
Mailing Address - Street 1:2335 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3559
Mailing Address - Country:US
Mailing Address - Phone:626-357-3207
Mailing Address - Fax:626-303-1116
Practice Address - Street 1:2335 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3559
Practice Address - Country:US
Practice Address - Phone:626-357-3207
Practice Address - Fax:626-303-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18686HMedicaid
CAZZT18686HMedicaid