Healthcare Provider Details

I. General information

NPI: 1033059381
Provider Name (Legal Business Name): COMPASS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKESITE DR
MARTIN GA
30557-3472
US

IV. Provider business mailing address

110 LAKESITE DR
MARTIN GA
30557-3472
US

V. Phone/Fax

Practice location:
  • Phone: 209-628-1169
  • Fax:
Mailing address:
  • Phone: 209-628-1169
  • Fax:

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: JUSTIN LUDWIG
Title or Position: OWNER
Credential: RN
Phone: 209-628-1169