Provider Demographics
| NPI: | 1720031768 |
|---|---|
| Name: | COMMUNITY CARE SERVICES LLC |
| Entity Type: | Organization |
| Organization Name: | COMMUNITY CARE SERVICES LLC |
| Other - Org Name: | COMMUNITY CARE SERVICES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CFO ACUTE CARE |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | BRETT |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MOORE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 775-982-6343 |
| Mailing Address - Street 1: | 1155 MILL ST # M14 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | RENO |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89502-1576 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 775-982-5262 |
| Mailing Address - Fax: | 775-982-5496 |
| Practice Address - Street 1: | 1155 MILL ST |
| Practice Address - Street 2: | |
| Practice Address - City: | RENO |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89502-1576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 775-982-5000 |
| Practice Address - Fax: | 775-982-4196 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | HOMETOWN HEALTH MANAGEMENT COMPANY |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-19 |
| Last Update Date: | 2023-12-27 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2086S0127X | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NV | 1720031768 | Medicaid | |
| DE5373 | Other | RR MEDICARE PTAN | |
| V109390 | Medicare PIN | ||
| NV | V109389 | Medicare PIN | |
| NV | V101879 | Medicare PIN | |
| NV | 1720031768 | Medicaid | |
| CA | CA149522 | Medicare PIN |
