Healthcare Provider Details

I. General information

NPI: 1366366924
Provider Name (Legal Business Name): COMPASSIONATE CARE PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E GRANADA BLVD STE 1
ORMOND BEACH FL
32176-6634
US

IV. Provider business mailing address

115 E GRANADA BLVD STE 1
ORMOND BEACH FL
32176-6634
US

V. Phone/Fax

Practice location:
  • Phone: 386-265-1441
  • Fax: 386-265-4066
Mailing address:
  • Phone: 386-265-1441
  • Fax: 386-265-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE CANNON
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-265-1441