Healthcare Provider Details

I. General information

NPI: 1467030031
Provider Name (Legal Business Name): COMPASSION CARE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 E COOLEY DR STE H
COLTON CA
92324-3948
US

IV. Provider business mailing address

1003 E COOLEY DR STE H
COLTON CA
92324-3948
US

V. Phone/Fax

Practice location:
  • Phone: 909-275-7634
  • Fax: 909-498-7775
Mailing address:
  • Phone: 909-275-7634
  • Fax: 909-498-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATEISHA MCDONALD
Title or Position: CEO
Credential:
Phone: 909-275-7634