Healthcare Provider Details

I. General information

NPI: 1679444020
Provider Name (Legal Business Name): COMMUNITY SUPPORT HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S MANGUM ST STE 100
DURHAM NC
27701-4689
US

IV. Provider business mailing address

555 S MANGUM ST STE 100
DURHAM NC
27701-4689
US

V. Phone/Fax

Practice location:
  • Phone: 984-480-4663
  • Fax:
Mailing address:
  • Phone: 984-480-4663
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RHONDA WALLACE
Title or Position: MEMBER
Credential:
Phone: 984-480-4663