MEDICARE: COMPASSIONATE COMPANIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205337938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COMPANIONS LLC

Provider Business Mailing Address
First Line	:	5441 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1749
Country	:	US
Telephone Number	:	757-235-7374
Fax Number	:	757-257-2062

Provider Business Practice Location Address
First Line	:	5441 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1749
Country	:	US
Telephone Number	:	757-235-7374
Fax Number	:	757-257-2062

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YVETTE BARRON
Credential	:
Telephone Number	:	757-235-7374

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	05/07/2018

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