1659989663 NPI number — COMPASSIONATE HOME CARE & STAFFING

Table of content: (NPI 1659989663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659989663 NPI number — COMPASSIONATE HOME CARE & STAFFING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE HOME CARE & STAFFING
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 & COMMUNITY SERVICES L.L.C.
Provider Other Organization Name Type Code:
3
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:
1659989663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4735 SEQUATCHIE MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEQUATCHIE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37374-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-327-5276
Provider Business Mailing Address Fax Number:
931-463-9008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 WEST MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SEWANEE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37375-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-327-5276
Provider Business Practice Location Address Fax Number:
931-463-9008
Provider Enumeration Date:
07/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
KRISTIE
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
931-327-5276

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1255848842 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659989663 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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