MEDICARE: COMMUNITY COMPREHENSIVE CARE 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	:	1295568277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COMPREHENSIVE CARE LLC

Provider Business Mailing Address
First Line	:	5150 ASTER PARK DR APT 2009
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-8796
Country	:	US
Telephone Number	:	513-663-2194
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 ASTER PARK DR APT 2009
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45011-8796
Country	:	US
Telephone Number	:	513-663-2194
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. THEOPHILUS K KUM
Credential	:
Telephone Number	:	513-663-2194

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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