Healthcare Provider Details

I. General information

NPI: 1700825668
Provider Name (Legal Business Name): COMMUNITY HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 PARK AVE NW STE 6
NORTON VA
24273-1631
US

IV. Provider business mailing address

311 PRINCETON RD STE 1
JOHNSON CITY TN
37601-2026
US

V. Phone/Fax

Practice location:
  • Phone: 276-439-1460
  • Fax: 276-439-1461
Mailing address:
  • Phone: 276-439-1460
  • Fax: 276-439-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206009050
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MARY LYNN KRUTAK
Title or Position: EVP/CFO
Credential:
Phone: 423-302-3423