Provider Demographics
NPI:1518732536
Name:COMMUNITY CENTRAL CARES LLC
Entity Type:Organization
Organization Name:COMMUNITY CENTRAL CARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ROSLYN
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-286-7950
Mailing Address - Street 1:253 MONARCH CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206
Mailing Address - Country:US
Mailing Address - Phone:980-286-7950
Mailing Address - Fax:
Practice Address - Street 1:5801 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6224
Practice Address - Country:US
Practice Address - Phone:980-286-7950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty