MEDICARE: C&C HOME CARE L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1558215616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&C HOME CARE L.L.C.

Provider Business Mailing Address
First Line	:	13654 VAN BUREN ST NE STE 300
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-4366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13654 VAN BUREN ST NE STE 300
Second Line	:
City	:	HAM LAKE
State	:	MN
Zip	:	55304-4366
Country	:	US
Telephone Number	:	763-205-3318
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER WALLACE
Credential	:
Telephone Number	:	952-358-1895

Provider Enumeration Date	:	02/25/2026
Last Update Date	:	03/02/2026

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