Healthcare Provider Details

I. General information

NPI: 1629982012
Provider Name (Legal Business Name): COMMUNITY CARE GROUP HOME LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E EVA BLVD APT 312
CHESAPEAKE VA
23320-6210
US

IV. Provider business mailing address

6047 CLEAR SPRINGS RD
VIRGINIA BEACH VA
23464-4637
US

V. Phone/Fax

Practice location:
  • Phone: 757-632-2970
  • Fax:
Mailing address:
  • Phone: 757-632-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. SHAWN STEPNEY
Title or Position: CEO/DIRECTOR
Credential:
Phone: 757-632-2970