College Community Services
Organization Active NPI Community/Behavioral Health Agency · Lake Isabella, CA
NPI 1104154533 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1104154533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- COLLEGE COMMUNITY SERVICES
- Practice address
- 2717 Nugget Avenue
Lake Isabella, CA 93240 - Phone
- (760) 379-3412
- Fax
- (760) 379-5332
- NPI assigned
- Nov 23, 2009
- Organization subpart
- No
Authorized official
- Name
- Tracy Ginter, MBA, CBCS
- Title
- Director of State Operations
- Phone
- (657) 465-9497
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 21
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100415000405 | CA | Part B Supplier - Clinic/Group Practice | 4183767999 |
Receives reassigned benefits from 26 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wasco, CA; Tehachapi, CA; Taft, CA; Santa Ana, CA; Ridgecrest, CA; Mojave, CA; Orange, CA; Anaheim, CA… |
National Provider Directory
- Tax ID family
- College Community Servi
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2717 Nugget Avenue
Lake Isabella, CA 93240
Mailing address
8337 Telegraph Rd Ste 300
Pico Rivera, CA 90660-4957
Phone (562) 467-5440
Other names
- Clarvida
Other providers in Lake Isabella, CA
- Avis Laureen Chadwick
- Amanda Kathleen Chase
- Nathaniel Chavez I
- Clinica Sierra Vista
- Clinica Sierra Vista
- College Community Services
- Christina Conlon
- Brian William Cosgrove Jr.
- Alanna Costello
- Theresa Jean Cunningham
All providers in Lake Isabella, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.