Basic Information
| Provider Information | |||||||||
| NPI: | 1376636068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY CARE SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088217777 | ||||||||
| FaxNumber: | 5088806155 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088217777 | ||||||||
| FaxNumber: | 5088806155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOSS | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5088217777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 261QM0801X | 4426 | MA | X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 320800000X | 1475210 | MA | X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 320800000X | 1474910 | MA | X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 323P00000X | 1475604 | MA | X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 3245S0500X | 1475640 | MA | X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
ID Information
| ID | Type | State | Issuer | Description | 1309161 | 05 | MA | MEDICAID | 1307223 | 05 | MA | MEDICAID | 1901249 | 05 | MA | MEDICAID | VC16549 | 01 | RI | DCYF | OTHER |