MEDICARE: ASONTASIA'S COMPASSIONATE CARE 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1295439933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASONTASIA'S COMPASSIONATE CARE LLC

Provider Business Mailing Address
First Line	:	10143 GROVE DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3404
Country	:	US
Telephone Number	:	727-331-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	10143 GROVE DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3404
Country	:	US
Telephone Number	:	727-331-4115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASONTASIA REYNOLDS
Credential	:
Telephone Number	:	727-331-4115

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	06/21/2023

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