MEDICARE: CBC HEALTHCARE, 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	:	1477197465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBC HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	3201 MONTGOMERY HWY STE 9
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-2113
Country	:	US
Telephone Number	:	334-446-0676
Fax Number	:	334-828-7196

Provider Business Practice Location Address
First Line	:	3201 MONTGOMERY HWY STE 9
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-2113
Country	:	US
Telephone Number	:	334-446-0676
Fax Number	:	334-828-7196

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. CLAUDE EDWARD CAMP III
Credential	:
Telephone Number	:	334-446-0676

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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