Provider Demographics
NPI:1700027737
Name:C&C CARE PROVIDERS
Entity Type:Organization
Organization Name:C&C CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOMEMAKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:201-313-6854
Mailing Address - Street 1:220 64TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3079
Mailing Address - Country:US
Mailing Address - Phone:201-313-6854
Mailing Address - Fax:
Practice Address - Street 1:220 64TH ST APT 12
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-3079
Practice Address - Country:US
Practice Address - Phone:201-313-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-21
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH05202200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health