Healthcare Provider Details

I. General information

NPI: 1558215616
Provider Name (Legal Business Name): C&C HOME CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13654 VAN BUREN ST NE STE 300
HAM LAKE MN
55304-4366
US

IV. Provider business mailing address

13654 VAN BUREN ST NE STE 300
HAM LAKE MN
55304-4366
US

V. Phone/Fax

Practice location:
  • Phone: 763-205-3318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER WALLACE
Title or Position: CEO
Credential:
Phone: 952-358-1895