Provider Demographics
NPI:1437131836
Name:COMMUNITY CHOICE HOME CARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY CHOICE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:740-574-9900
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-0148
Mailing Address - Country:US
Mailing Address - Phone:740-574-9900
Mailing Address - Fax:740-574-9064
Practice Address - Street 1:7318 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5665
Practice Address - Country:US
Practice Address - Phone:740-574-9900
Practice Address - Fax:740-574-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084900Medicaid
OH2018195Medicaid