Healthcare Provider Details

I. General information

NPI: 1942655683
Provider Name (Legal Business Name): COMPANION CARE AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SE BROAD ST
METTER GA
30439-4428
US

IV. Provider business mailing address

58 SE BROAD ST
METTER GA
30439-4428
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-4500
  • Fax: 912-685-4540
Mailing address:
  • Phone: 912-685-4500
  • Fax: 912-685-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number087-R-0006
License Number StateGA

VIII. Authorized Official

Name: STEPHEN TAYLOR
Title or Position: OWNER
Credential:
Phone: 912-685-4500