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General NPI Number Information
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NPI Number | 1629982012
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE GROUP HOME LLC.
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 1232 E EVA BLVD APT 312
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City | CHESAPEAKE
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State | VA
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Zip | 23320-6210
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Country | US
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Telephone | 757-632-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 6047 CLEAR SPRINGS RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4637
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Country | US
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Telephone | 757-632-2970
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MRS. SHAWN STEPNEY
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Credential |
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Telephone | 757-632-2970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | NULL
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