1497256580 NPI number — COMMUNITY COMPANION CARE INC

Table of content: (NPI 1497256580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497256580 NPI number — COMMUNITY COMPANION CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY COMPANION CARE 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:
1497256580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2842 HIGHWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46322-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-474-0454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2842 HIGHWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-474-0454
Provider Business Practice Location Address Fax Number:
219-836-1849
Provider Enumeration Date:
02/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
AFAB
Authorized Official First Name:
SYED
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
888-474-0454

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  18-0143001-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18-014300-1 . This is a "INDIANA DEPARTMENT OF HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com