Provider Demographics
NPI:1679081525
Name:COMMUNITY CARE MANAGEMENT SERVICES
Entity type:Organization
Organization Name:COMMUNITY CARE MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, CPC, CPC-I
Authorized Official - Phone:501-813-0879
Mailing Address - Street 1:505 CAMBRIDGE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2169
Mailing Address - Country:US
Mailing Address - Phone:501-813-0879
Mailing Address - Fax:501-313-5355
Practice Address - Street 1:505 CAMBRIDGE PLACE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2169
Practice Address - Country:US
Practice Address - Phone:501-813-0879
Practice Address - Fax:501-313-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management