Provider Demographics
NPI:1649890146
Name:COMMUNITY CARE OF KNOXVILLE LLC
Entity type:Organization
Organization Name:COMMUNITY CARE OF KNOXVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:712-210-6296
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-0287
Mailing Address - Country:US
Mailing Address - Phone:641-842-4618
Mailing Address - Fax:
Practice Address - Street 1:205 N IOWA ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-2833
Practice Address - Country:US
Practice Address - Phone:641-842-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness