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General NPI Number Information
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NPI Number | 1700021656
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Entity Type | Organization
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Legal Business Name | C&C LTD
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Dates
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Enumeration Date | 12/06/2008
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Last Update Date | 12/06/2008
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Provider Practice Location Address
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Address Line | 7161 SILVER LAKE BLVD SUITE #201
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City | ALEXANDRIA
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State | VA
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Zip | 22315-3216
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Country | US
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Telephone | 954-464-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 7161 SILVER LAKE BLVD SUITE #201
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City | ALEXANDRIA
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State | VA
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Zip | 22315-3216
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Country | US
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Telephone | 954-464-6371
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SHAWN A COLE
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Credential | N/A
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Telephone | 954-464-6371
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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 | 0855483
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License Number State | VA
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