Provider Demographics
NPI:1700283678
Name:COMMUNITY CAREGIVERS, LLC
Entity Type:Organization
Organization Name:COMMUNITY CAREGIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ONG
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-830-2001
Mailing Address - Street 1:424 E LONGVIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2167
Mailing Address - Country:US
Mailing Address - Phone:920-830-2001
Mailing Address - Fax:920-830-2090
Practice Address - Street 1:424 E LONGVIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2167
Practice Address - Country:US
Practice Address - Phone:920-830-2001
Practice Address - Fax:920-830-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100037993Medicaid