MEDICARE: COMMUNITY CARE CENTER OF THE NORTHEAST

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	253Z00000X	In Home Supportive Care Agency	12463601	PA

General Provider Information

NPI Number	:	1265847008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE CENTER OF THE NORTHEAST

Provider Business Mailing Address
First Line	:	2417 WELSH RD
Second Line	:	SUITE 202
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2213
Country	:	US
Telephone Number	:	215-335-4416
Fax Number	:	215-338-4426

Provider Business Practice Location Address
First Line	:	2417 WELSH RD
Second Line	:	SUITE 202
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2213
Country	:	US
Telephone Number	:	215-335-4416
Fax Number	:	215-338-4426

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NANCY H STEINKE
Credential	:
Telephone Number	:	215-335-4416

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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