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General NPI Number Information
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NPI Number | 1700825668
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Entity Type | Organization
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Legal Business Name | COMMUNITY HOME CARE, INC.
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 1490 PARK AVE NW STE 6
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City | NORTON
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State | VA
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Zip | 24273-1631
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Country | US
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Telephone | 276-439-1460
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Fax | 276-439-1461
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Provider Business Mailing Address
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Address Line | 311 PRINCETON RD STE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2026
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Country | US
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Telephone | 276-439-1460
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Fax | 276-439-1461
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Authorized Official
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Title or Position | EVP/CFO
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Name | MR. MARY LYNN KRUTAK
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Credential |
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Telephone | 423-302-3423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0206009050
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License Number State | VA
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