Provider Demographics
NPI:1881728392
Name:COMMUNITY CARE NETWORK
Entity type:Organization
Organization Name:COMMUNITY CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEN-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-269-6251
Mailing Address - Street 1:1629 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1541
Mailing Address - Country:US
Mailing Address - Phone:334-269-6251
Mailing Address - Fax:334-269-6253
Practice Address - Street 1:1629 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1541
Practice Address - Country:US
Practice Address - Phone:334-269-6251
Practice Address - Fax:334-269-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL5127261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health