MEDICARE: COMMUNITY CARE AGENCY, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679605281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE AGENCY, LLC.

Provider Business Mailing Address
First Line	:	900 KINGS HWY N
Second Line	:	SUITE# 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1516
Country	:	US
Telephone Number	:	856-665-7002
Fax Number	:	856-665-7009

Provider Business Practice Location Address
First Line	:	900 KINGS HWY N
Second Line	:	SUITE# 210
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1516
Country	:	US
Telephone Number	:	856-665-7002
Fax Number	:	856-665-7009

Authorized Official
Title or Position	:	VP OF OPERATION
Name	:	MR. HUNG HOANG NGUYEN
Credential	:
Telephone Number	:	856-665-7002

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	01/11/2016

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