Provider Demographics
NPI:1871363564
Name:COMMUNITY CARE MOBILE CLINIC LLC
Entity type:Organization
Organization Name:COMMUNITY CARE MOBILE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:TYMES
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:229-410-9174
Mailing Address - Street 1:PO BOX 1636
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-1636
Mailing Address - Country:US
Mailing Address - Phone:229-410-9174
Mailing Address - Fax:
Practice Address - Street 1:169 PACKING HOUSE RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-7932
Practice Address - Country:US
Practice Address - Phone:229-410-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty