Healthcare Provider Details

I. General information

NPI: 1477880979
Provider Name (Legal Business Name): COMMUNITY HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PALMETTO PL
BYESVILLE OH
43723-9602
US

IV. Provider business mailing address

108 PALMETTO PL
BYESVILLE OH
43723-9602
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-1610
  • Fax:
Mailing address:
  • Phone: 740-685-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberE-0001153
License Number StateOH

VIII. Authorized Official

Name: MR. CHESTER JAMES LARRICK
Title or Position: PRESIDENT/CEO
Credential: LPCC-S
Phone: 740-685-1610