Provider Demographics
NPI:1861131831
Name:COMMON CARE HOMES LLC
Entity type:Organization
Organization Name:COMMON CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:832-492-8311
Mailing Address - Street 1:5328 HARTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4001
Mailing Address - Country:US
Mailing Address - Phone:832-492-8311
Mailing Address - Fax:
Practice Address - Street 1:625 LAKELAND EAST DR STE E
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8817
Practice Address - Country:US
Practice Address - Phone:832-492-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMON CARE HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-30
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08329532Medicaid