Provider Demographics
NPI:1710973235
Name:COMMUNITY HOMECARE INC
Entity Type:Organization
Organization Name:COMMUNITY HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:R TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-728-2320
Mailing Address - Street 1:107 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-2025
Mailing Address - Country:US
Mailing Address - Phone:217-728-2320
Mailing Address - Fax:217-728-2305
Practice Address - Street 1:107 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-2025
Practice Address - Country:US
Practice Address - Phone:217-728-2320
Practice Address - Fax:217-728-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147774Medicare Oscar/Certification