Provider Demographics
NPI:1679605281
Name:COMMUNITY CARE AGENCY, LLC.
Entity Type:Organization
Organization Name:COMMUNITY CARE AGENCY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-665-7002
Mailing Address - Street 1:900 KINGS HWY N
Mailing Address - Street 2:SUITE# 210
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1516
Mailing Address - Country:US
Mailing Address - Phone:856-665-7002
Mailing Address - Fax:856-665-7009
Practice Address - Street 1:900 KINGS HWY N
Practice Address - Street 2:SUITE# 210
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1516
Practice Address - Country:US
Practice Address - Phone:856-665-7002
Practice Address - Fax:856-665-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114537Medicaid