Organization
COMMUNITY CARE
Active
Other names
CCHAP
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA MCMATH (EXECUTIVE DIRECTOR)
(707) 462-3041
Entity
Organization
Contact information
Practice address
14644B LAKESHORE DR, CLEARLAKE, CA 95422-9290
(707) 995-1606
(707) 995-0309
Mailing address
14644B LAKESHORE DR, CLEARLAKE, CA 95422-9290
(707) 995-1606
(707) 995-0309
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7975326
—
CA
Enumeration date
11/27/2007
Last updated
11/27/2007
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