1477743367 NPI number — COMPASSIONATE HOME CARE INC

Table of content: (NPI 1477743367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477743367 NPI number — COMPASSIONATE HOME CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE HOME CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPASSIONATE HOME CARE LLP
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477743367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14818 COUNTY ROAD 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBUSH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-782-4146
Provider Business Mailing Address Fax Number:
218-782-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14818 COUNTY ROAD 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBUSH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-782-4146
Provider Business Practice Location Address Fax Number:
218-782-4191
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EEG
Authorized Official First Name:
SARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
218-782-4191

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7855 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: R 143136-4 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25298 . This is a "HFID, DEPT OF HEALTH , CL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 014970000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com