Healthcare Provider Details

I. General information

NPI: 1588279442
Provider Name (Legal Business Name): C & C HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 HOLDENS CROSS RD
WILSON NC
27893-8253
US

IV. Provider business mailing address

5119 HOLDENS CROSS RD
WILSON NC
27893-8253
US

V. Phone/Fax

Practice location:
  • Phone: 252-245-6035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIWANA HORNE
Title or Position: CEO
Credential:
Phone: 252-245-6035