Provider Demographics
NPI:1932213923
Name:COMMUNITY CARE INC
Entity Type:Organization
Organization Name:COMMUNITY CARE INC
Other - Org Name:COMMUNITY CARE INC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-231-4000
Mailing Address - Street 1:1555 S LAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1924
Mailing Address - Country:US
Mailing Address - Phone:414-902-2397
Mailing Address - Fax:414-649-9149
Practice Address - Street 1:1555 S LAYTON BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1924
Practice Address - Country:US
Practice Address - Phone:414-902-2397
Practice Address - Fax:414-649-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
WI8638-423336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100036712Medicaid
2110889OtherPK