Provider Demographics
NPI:1144606500
Name:COMMUNITY COMPANION HOME CARE, LLC
Entity Type:Organization
Organization Name:COMMUNITY COMPANION HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMORA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-659-6453
Mailing Address - Street 1:3288 HARMONY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:NEBO
Mailing Address - State:NC
Mailing Address - Zip Code:28761-5707
Mailing Address - Country:US
Mailing Address - Phone:828-659-6453
Mailing Address - Fax:828-655-1693
Practice Address - Street 1:3288 HARMONY GROVE RD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-5707
Practice Address - Country:US
Practice Address - Phone:828-659-6453
Practice Address - Fax:828-655-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720138712Medicaid