MEDICARE: COMPASSION CARE CENTER, INC.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1295066744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	2614 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3057
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-298-7141

Provider Business Practice Location Address
First Line	:	2614 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3057
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-298-7141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JUDY COMER
Credential	:
Telephone Number	:	310-230-5574

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	01/22/2010

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Directions to “COMPASSION CARE CENTER, INC. ” Practice Location

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