Healthcare Provider Details

I. General information

NPI: 1285695734
Provider Name (Legal Business Name): COMMUNITY CARE HOME MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7318 OHIO RIVER RD
PORTSMOUTH OH
45662-5665
US

IV. Provider business mailing address

PO BOX 177
WHEELERSBURG OH
45694-0177
US

V. Phone/Fax

Practice location:
  • Phone: 740-574-9549
  • Fax: 740-574-9064
Mailing address:
  • Phone: 740-574-9549
  • Fax: 740-574-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. LESLIE J CUNNINGHAM
Title or Position: MEMBER
Credential:
Phone: 740-574-9549