CC Health Care Agency Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

CC HEALTH CARE AGENCY INC.

Practice address

1102 W Somerville Ave
Philadelphia, PA 19141-2904

Phone

(267) 304-6775

NPI assigned

May 17, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Medith CharlesNPI 1861256505

Title

Owner / President

Phone

(267) 304-6775

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Home health agency certification: CCN 398352

Legal name

CC HEALTH CARE AGENCY INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Oct 17, 2023

Last certification

Sep 20, 2023

Organization structure

CorporationProprietary

Incorporated

May 2, 2019 in PA

Enrollment address

6302 Rising Sun Ave
Philadelphia, PA 19111-5630

Listed as

CC Health Care Agency, Inc.CCN 398352

Ownership

-

Certified

Oct 17, 2023

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Medith Codio Charles

  • Licensed Practical Nurse
  • Philadelphia, PA
  • NPI 1861256505
  NPD Authorized official
• Stephanie Charles, LPN

  • Home Health Agency
  • Philadelphia, PA
  • NPI 1073378931
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1396301149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 W SOMERVILLE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412904",
            "telephone_number": "267-304-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W SOMERVILLE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191412904",
            "telephone_number": "267-304-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CC HEALTH CARE AGENCY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "MEDITH",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "267-304-6775"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise P Cawley, RPH
• Mari Angelica Cayabyab, PHARMD
• Amber Dawn Caylor, BSN, RN
• Christiani Cayo
• Lisa Marie Cazes, OTR
• CC Home Care LLC
• CCN America LP
• CCN America, LP
• CD Dental
• CD Pennsylvania Dental, P.C.

• Home Health Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Home Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.