Healthcare Provider Details

I. General information

NPI: 1235667239
Provider Name (Legal Business Name): COMPASSIONATE COMPANION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 E BROADWAY BLVD STE 600
TUCSON AZ
85711-3554
US

IV. Provider business mailing address

4400 E BROADWAY BLVD STE 600
TUCSON AZ
85711-3554
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-2555
  • Fax: 520-300-7586
Mailing address:
  • Phone: 520-327-2555
  • Fax: 520-300-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. KAREN D HEYSE
Title or Position: OWNER
Credential:
Phone: 520-327-2555