Provider Demographics
NPI:1720322068
Name:COMMUNITY CARE COLLABORATIVE
Entity Type:Organization
Organization Name:COMMUNITY CARE COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KNODEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-978-8191
Mailing Address - Street 1:1111 E CESAR CHAVEZ ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4209
Mailing Address - Country:US
Mailing Address - Phone:512-978-8000
Mailing Address - Fax:512-978-8156
Practice Address - Street 1:1111 E CESAR CHAVEZ ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4209
Practice Address - Country:US
Practice Address - Phone:512-978-8000
Practice Address - Fax:512-978-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health