MEDICARE: COMMUNITY HOMECARE SERVICES, 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	HC 3537	NC

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	:	1841488210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOMECARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	5410 FREDERICK ST.
Second Line	:
City	:	INDIANTRAIL
State	:	NC
Zip	:	28079
Country	:	US
Telephone Number	:	704-323-9266
Fax Number	:	704-563-8477

Provider Business Practice Location Address
First Line	:	543 COX RD
Second Line	:	SUITE B-2
City	:	GASTONIA
State	:	NC
Zip	:	28054-0607
Country	:	US
Telephone Number	:	704-323-9266
Fax Number	:	704-563-8477

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. RREGINA DEPASS
Credential	:
Telephone Number	:	704-323-9266

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/10/2007

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