Provider Demographics
NPI:1881922102
Name:CC HEALTHCARE SYSTEMS, LLC
Entity type:Organization
Organization Name:CC HEALTHCARE SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-629-3614
Mailing Address - Street 1:705 LANDA STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6163
Mailing Address - Country:US
Mailing Address - Phone:830-629-3614
Mailing Address - Fax:830-629-2438
Practice Address - Street 1:705 LANDA STREET
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6163
Practice Address - Country:US
Practice Address - Phone:830-629-3614
Practice Address - Fax:830-629-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2964208D00000X
TXJ7341261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310114903Medicaid
TX310114903Medicaid