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General NPI Number Information
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NPI Number | 1558215616
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Entity Type | Organization
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Legal Business Name | C&C HOME CARE L.L.C.
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 13654 VAN BUREN ST NE STE 300
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City | HAM LAKE
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State | MN
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Zip | 55304-4366
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Country | US
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Telephone | 763-205-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 13654 VAN BUREN ST NE STE 300
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City | HAM LAKE
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State | MN
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Zip | 55304-4366
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTOPHER WALLACE
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Credential |
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Telephone | 952-358-1895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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