MEDICARE: COMMUNITY CARE LIVING, 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	:	1891638466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE LIVING, LLC

Provider Business Mailing Address
First Line	:	11746 S HARRELLS FERRY RD STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2375
Country	:	US
Telephone Number	:	225-256-0412
Fax Number	:	225-256-0908

Provider Business Practice Location Address
First Line	:	11746 S HARRELLS FERRY RD STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2375
Country	:	US
Telephone Number	:	225-256-0412
Fax Number	:	225-256-0908

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CHARLOTTA LORETTA MOORE
Credential	:	RN
Telephone Number	:	225-256-0412

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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