Provider Demographics
NPI:1033296363
Name:COMMUNITY CARE NETWORK INC
Entity type:Organization
Organization Name:COMMUNITY CARE NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:216-283-3865
Mailing Address - Street 1:3167 FULTON RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1465
Mailing Address - Country:US
Mailing Address - Phone:216-283-3865
Mailing Address - Fax:216-651-1590
Practice Address - Street 1:3167 FULTON RD STE 111
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1465
Practice Address - Country:US
Practice Address - Phone:216-283-3865
Practice Address - Fax:216-651-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X, 3336M0003X, 333600000X
OH021546950033336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586607Medicaid
2080327OtherPK
5566870001Medicare NSC