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1-866-992-6600

Join Our Network

Community Care offers member-centered care to elders and adults with intellectual and physical disabilities in Eastern Wisconsin. We’re the only Wisconsin organization to offer all three long-term care programs of Family Care, Partnership and Program of All-Inclusive Care for the Elderly (PACE). We are always interested in adding providers to our network who share Community Care’s mission of delivering quality, cost-effective care to those we serve.

Interested in joining the Community Care provider network? Download an application below to get started. All applications are available in Adobe PDF and Microsoft Word formats.

If you have questions or need confirmation as to which application you should complete, call 1-866-937-2783 and select option 2.

General Application OOAFH ApplicationTransportation Application    Health Care Group Application


General Provider Application - PDF General Provider Application - MS Word OOAFH Application - Microsoft Word Format OOAFH Application - PDF Format Health Care Group Application - PDF Health Care Group Application - MS Word Transportation Provider Application - PDF Transportation Provider Application - MS Word

Checklist of Materials to Send With Your Application

All required items (on the application checklist) must be submitted with general application, transportation application or OOAFH application to be considered. If all required items are not submitted at time of application, applications will be denied and providers will need to reapply at a future date.

  • All licenses and/or certifications
  • Certificate of Insurance with Community Care, Inc. listed as the certificate holder (No Declaration Page or Insurance Application or Insurance Binder)
  • Attestation Form - (Word or PDF format) to be completed by all providers
  • W-9 Form (to be completed by all providers)
  • Data Collection Form - Fiscal (to be completed by all corporate residential providers and submitted with the General Application)
  • Residential Summary - (Word or PDF format) to be completed by all residential providers
  • Direct Deposit Form - (Word or PDF format) with a cancelled or voided check
  • Program Statement required for all certified or licensed providers

Submit Your Completed Application To:

  Mail:  Community Care, Inc.
            ATTN: Provider Management
            1801 Dolphin Drive
            Waukesha, WI 53186

Email:  contractinquiries@communitycareinc.org

  Fax:  (262) 446-6707


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 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
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