Healthcare Provider Details

I. General information

NPI: 1952915787
Provider Name (Legal Business Name): COMMUNITY CENTERED HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12803 MARLOW PL
SILVER SPRING MD
20904-7143
US

IV. Provider business mailing address

12803 MARLOW PL
SILVER SPRING MD
20904-7143
US

V. Phone/Fax

Practice location:
  • Phone: 240-605-6954
  • Fax: 301-890-3940
Mailing address:
  • Phone: 240-605-6954
  • Fax: 301-890-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MISS CYNTHIA RENEE BRUNSON
Title or Position: MSN, RN, APHN, CEO
Credential: RN
Phone: 240-605-6954