Community Clinical Services, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Auburn, ME
NPI 1942592571 · NPPES record last updated Oct 22, 2020
Key facts
- NPI
- 1942592571
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY CLINICAL SERVICES, INC.
- Practice address
- 77 Harris St
Auburn, ME 04210-4671 - Phone
- (207) 782-6827
- Fax
- (207) 376-0090
- NPI assigned
- May 16, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY CLINICAL SERVICES, INC.
Authorized official
- Name
- Coleen L Elias
- Title
- Ceo/Cfo
- Phone
- (207) 513-3897
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 13
Corporate family (same tax ID) 22
Practitioners 15
-
Jordan A Albair, FNP
-
Jonathan Albert Burnham, LMSW-CC
-
Mary Cronin-Finn, LCPC
-
Rachel E Goulet, PMHNP
-
Sarah M Jones, FNP-C
-
Carolyn Miles McNamara, F.N.P.
-
Annie M Rice, PA-C
-
Amy A. Ampuja, NP
-
Jennifer Duhon, PA
-
Cassandra Os, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Federally qualified health center certification: CCN 201894
- Legal name
- COMMUNITY CLINICAL SERVICES INC
- Doing business as
- EDWARD LITTLE SCHOOL BASED HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 22, 2011
- Last certification
- Jun 22, 2011
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 19, 1985 in ME
- Enrollment address
- 77 Harris St
Auburn, ME 42104671
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Frances a Rodgers |
Corporate Director | May 24, 2021 | 11.11% |
| Coleen L Elias |
Corporate Officer |
Mar 11, 2020 | |
| W-2 Managing Employee |
Mar 11, 2020 | ||
| Operational/Managerial Control |
Mar 11, 2020 | ||
| Elizabeth a Keene |
Corporate Director | Jan 22, 2015 | 11.11% |
| Paige a Hagerstrom |
Corporate Director | May 23, 2016 | 11.11% |
| Hawo a Abdille |
Corporate Officer |
Jun 28, 2021 | 11.11% |
| Corporate Director |
May 1, 2020 | 11.11% | |
| Abdi Abdalla |
Corporate Director | Apr 25, 2022 | 11.11% |
| Lynn Ward |
Corporate Officer |
Jun 30, 2020 | 11.11% |
| Corporate Director |
Sep 24, 2018 | 11.11% | |
| Andrew Lunn |
Corporate Officer |
Jan 23, 2023 | 11.11% |
| Corporate Director |
Jan 23, 2023 | 11.11% | |
| Laura L Minkowsky-Gormley |
Corporate Officer |
Jun 30, 2020 | 11.11% |
| Corporate Director |
Jun 25, 2018 | 11.11% | |
| Abdulkerim M Said |
Corporate Director | Nov 16, 2020 | 11.11% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110715000266 | ME | Part a Provider - Federally Qualified Health Center (FQHC) | 0042101099 |
1 other NPI on this enrollment Practice locations: Auburn, ME |
National Provider Directory
- Tax ID family
- Community Clinical Services Inc
- Part of
- Community Clinical Services Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
77 Harris St
Auburn, ME 04210-4671
Mailing address
PO Box 95000 LBX 7660
Philadelphia, PA 19195-0001
Phone (207) 777-8202
Other names
- Edward Little School Based Health Center
Other providers in Auburn, ME
- Community Clinical Services, Inc.
- Community Clinical Services, Inc.
- Community Clinical Services, Inc.
- Community Clinical Services, Inc.
- Community Clinical Services, Inc.
- Community Concepts Inc
- Confluence Speech Therapy LLC
- Andrea Landry Conley
- Paula Connor-Crouch
- Sierra Connor-Schade
All providers in Auburn, ME · Federally Qualified Health Center (FQHC) in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.