=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891787149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HOME SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 7TH ST N
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-513-7144
-----------------------------------------------------
Fax | 239-513-7049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8569 350 7TH ST NORTH
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34101-8569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-513-7144
-----------------------------------------------------
Fax | 239-513-7049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF BILLING
-----------------------------------------------------
Name | MRS. CATHY J LEGGETT
-----------------------------------------------------
Credential | BILLING MGR
-----------------------------------------------------
Telephone | 239-513-7144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------