Provider Demographics
NPI:1730472325
Name:COMMUNITY CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITY CLINICAL SERVICES, INC.
Other - Org Name:LEWISTON HIGH SCHOOL BASED HEALTH CENTER - PSYCH PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
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:PO BOX 95000 LBX 7660
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:207-777-8202
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:156 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5626
Practice Address - Country:US
Practice Address - Phone:207-795-4144
Practice Address - Fax:207-795-4147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CLINICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-16
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201896Medicare PIN