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General NPI Number Information
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NPI Number | 1194508697
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Entity Type | Organization
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Legal Business Name | CCHEAVENLY CARE LLC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 17 E PARKWAY AVE
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City | CHESTER
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State | PA
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Zip | 19013-4606
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Country | US
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Telephone | 267-256-9269
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Fax |
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Provider Business Mailing Address
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Address Line | 17 E PARKWAY AVE
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City | CHESTER
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State | PA
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Zip | 19013-4606
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Country | US
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Telephone | 267-256-9269
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARAM COLMON
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Credential |
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Telephone | 267-256-9269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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