| Organization Name: | COMMUNITY CARE NETWORK, INC |
| NPI Number: | 1053747584 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LUIS MOLINA (ADMINISTRATOR) |
| Mailing Address: | 3800 Saint Mary Rd Suite 204 Valparaiso |
| State: | IN US |
| Postal Code: | 463833986 |
| Phone Number: | 2192863765 |
| Fax Number: | 2192863766 |
| NPI Enumeration Date: | 09/16/2013 |
| NPI Last Update Date: | 09/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |