MEDICARE: COMMUNITY FIRST HOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1215190475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY FIRST HOMECARE LLC

Provider Business Mailing Address
First Line	:	5777 W MAPLE RD STE 176
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4448
Country	:	US
Telephone Number	:	248-970-2111
Fax Number	:	810-588-4556

Provider Business Practice Location Address
First Line	:	5777 W MAPLE RD STE 176
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4448
Country	:	US
Telephone Number	:	248-970-2111
Fax Number	:	810-588-4556

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. JONATHAN S SHAMMAS
Credential	:
Telephone Number	:	810-360-0574

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/02/2020

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