1205997863 NPI number — COMPASSIONATE HOME CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205997863 NPI number — COMPASSIONATE HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE HOME CARE
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:
Provider Other Organization Name Type Code:
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:
1205997863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 ROBERTS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-671-0006
Provider Business Mailing Address Fax Number:
910-671-0212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2406 ROBERTS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-671-0006
Provider Business Practice Location Address Fax Number:
910-671-0212
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
RN DIRECTOR
Authorized Official Telephone Number:
910-671-0006

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  159630 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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