Provider Demographics
NPI:1295568277
Name:COMMUNITY COMPREHENSIVE CARE LLC
Entity type:Organization
Organization Name:COMMUNITY COMPREHENSIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-663-2194
Mailing Address - Street 1:5150 ASTER PARK DR APT 2009
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8796
Mailing Address - Country:US
Mailing Address - Phone:513-663-2194
Mailing Address - Fax:
Practice Address - Street 1:5150 ASTER PARK DR APT 2009
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45011-8796
Practice Address - Country:US
Practice Address - Phone:513-663-2194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health