Healthcare Provider Details

I. General information

NPI: 1811136674
Provider Name (Legal Business Name): COMMUNITY CARE ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 55 STREET AA4
BROOKLYN NY
11220
US

IV. Provider business mailing address

246 55 STREET AA4
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7274
  • Fax: 718-630-7261
Mailing address:
  • Phone: 718-630-7274
  • Fax: 718-630-7261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0496L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0496L001
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID ROSE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 718-630-6125