MEDICARE: CC HEALTH CARE AGENCY INC.

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	:	1396301149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CC HEALTH CARE AGENCY INC.

Provider Business Mailing Address
First Line	:	1102 W SOMERVILLE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2904
Country	:	US
Telephone Number	:	267-304-6775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 W SOMERVILLE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2904
Country	:	US
Telephone Number	:	267-304-6775
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MEDITH CHARLES
Credential	:
Telephone Number	:	267-304-6775

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	02/19/2024

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