MEDICARE: COMMUNITY HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1528443330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOME CARE LLC

Provider Business Mailing Address
First Line	:	547 7 LKS N
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-9767
Country	:	US
Telephone Number	:	910-690-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	201B S MAIN ST # B
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2020
Country	:	US
Telephone Number	:	910-690-0582
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	GREGORY DOUGLAS RICHARDSON
Credential	:
Telephone Number	:	910-690-0582

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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Directions to “COMMUNITY HOME CARE LLC ” Practice Location

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