Provider Demographics
NPI:1497256580
Name:COMMUNITY COMPANION CARE INC
Entity Type:Organization
Organization Name:COMMUNITY COMPANION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:AFAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-474-0454
Mailing Address - Street 1:2842 HIGHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1629
Mailing Address - Country:US
Mailing Address - Phone:888-474-0454
Mailing Address - Fax:
Practice Address - Street 1:2842 HIGHWAY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1629
Practice Address - Country:US
Practice Address - Phone:888-474-0454
Practice Address - Fax:219-836-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18-0143001-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18-014300-1OtherINDIANA DEPARTMENT OF HEALTH