Provider Demographics
NPI:1942633755
Name:COMMUNITY COALITION ALLIANCE
Entity Type:Organization
Organization Name:COMMUNITY COALITION ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MACINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-408-2009
Mailing Address - Street 1:516 S 10TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FERNANDINA
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3530
Mailing Address - Country:US
Mailing Address - Phone:904-277-3699
Mailing Address - Fax:904-277-7043
Practice Address - Street 1:516 S 10TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:FERNANDINA
Practice Address - State:FL
Practice Address - Zip Code:32034-3530
Practice Address - Country:US
Practice Address - Phone:904-277-3699
Practice Address - Fax:904-277-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health