Healthcare Provider Details

I. General information

NPI: 1255291456
Provider Name (Legal Business Name): COMPASSIONATE QUALITY CARE HOMEMAKER AND COMPANION SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 DENHAM RD E
JACKSONVILLE FL
32208-2531
US

IV. Provider business mailing address

476 RIVERSIDE AVE # 622
JACKSONVILLE FL
32202-4912
US

V. Phone/Fax

Practice location:
  • Phone: 214-937-1219
  • Fax:
Mailing address:
  • Phone: 214-937-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BREONSHAY D KING
Title or Position: OWNER
Credential:
Phone: 214-937-1219