Provider Demographics
NPI:1053546028
Name:COMMUNITY HOMECARE SERVICES INC
Entity type:Organization
Organization Name:COMMUNITY HOMECARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-323-9266
Mailing Address - Street 1:5410 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6509
Mailing Address - Country:US
Mailing Address - Phone:704-289-3506
Mailing Address - Fax:704-289-9484
Practice Address - Street 1:1654 DICKERSON BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2883
Practice Address - Country:US
Practice Address - Phone:704-289-3506
Practice Address - Fax:704-289-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3537251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601388Medicaid