Basic Information
Provider Information
NPI: 1821369976
EntityType: 2
ReplacementNPI:  
OrganizationName: COMMUNITY HOME CARE OF ROBESON COUNTY, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: COMMUNITY HOME CARE AND HOSPICE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 655 BRAWLEY SCHOOL RD
Address2: SUITE 200
City: MOORESVILLE
State: NC
PostalCode: 281179125
CountryCode: US
TelephoneNumber: 7046642876
FaxNumber: 7046641306
Practice Location
Address1: 1528 EVANS ST STE L1
Address2:  
City: GREENVILLE
State: NC
PostalCode: 278345312
CountryCode: US
TelephoneNumber: 2523415367
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/21/2012
LastUpdateDate: 04/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KLEBERG
AuthorizedOfficialFirstName: JESSICA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OF LEGAL AFFAIRS
AuthorizedOfficialTelephone: 7046642876
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251G00000XHOS4010NCY AgenciesHospice Care, Community Based 

No ID Information.


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