Provider Demographics
NPI:1750792131
Name:COMMUNITY CARE SYSTEMS, INC.
Entity type:Organization
Organization Name:COMMUNITY CARE SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-698-0200
Mailing Address - Street 1:405 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-2312
Mailing Address - Country:US
Mailing Address - Phone:217-698-0200
Mailing Address - Fax:217-698-9862
Practice Address - Street 1:4415 HARRISON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1910
Practice Address - Country:US
Practice Address - Phone:708-449-8390
Practice Address - Fax:708-449-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL951Medicaid