1497721716 NPI number — COMMONWEALTH HOME HEALTH CARE, INC.

Table of content: (NPI 1497721716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497721716 NPI number — COMMONWEALTH HOME HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH HOME HEALTH 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:
6
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:
1497721716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
479 PINEY FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24540-4044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-797-2332
Provider Business Mailing Address Fax Number:
434-799-4114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
479 PINEY FOREST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-797-2332
Provider Business Practice Location Address Fax Number:
434-797-9230
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLENICK
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official Telephone Number:
434-797-2332

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0206008455 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: 00755 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 60-006105 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0481P . This is a "BC/BS OF NORTH CAROLINA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 017792 . This is a "ANTHEM TRIGON BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7700444 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9133607 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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