1790198323 NPI number — COMPASSIONATE HOME HEALTH CARE LLC

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 1790198323 NPI number — COMPASSIONATE HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE HOME HEALTH CARE LLC
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:
1790198323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUGHMAN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-438-7946
Provider Business Mailing Address Fax Number:
863-438-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 PLUMOSO LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-438-7946
Provider Business Practice Location Address Fax Number:
863-438-7950
Provider Enumeration Date:
06/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
MMBR CEO (FOUNDER)
Authorized Official Telephone Number:
863-438-7946

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; 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)





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