MEDICARE: COMMUNITY PRIDE ASSISTED LIVING, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1588543417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PRIDE ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	287 BERTIE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8855
Country	:	US
Telephone Number	:	910-783-8143
Fax Number	:

Provider Business Practice Location Address
First Line	:	287 BERTIE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8855
Country	:	US
Telephone Number	:	910-783-8143
Fax Number	:	910-783-8143

Authorized Official
Title or Position	:	OWNER
Name	:	LASHONDA CAPEL
Credential	:
Telephone Number	:	910-783-8143

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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