1841488210 NPI number — COMMUNITY HOMECARE SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841488210 NPI number — COMMUNITY HOMECARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOMECARE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841488210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 FREDERICK ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANTRAIL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-323-9266
Provider Business Mailing Address Fax Number:
704-563-8477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
543 COX RD
Provider Second Line Business Practice Location Address:
SUITE B-2
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-0607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-323-9266
Provider Business Practice Location Address Fax Number:
704-563-8477
Provider Enumeration Date:
10/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEPASS
Authorized Official First Name:
RREGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-323-9266

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC 3537 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3418066 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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