Healthcare Provider Details

I. General information

NPI: 1770092876
Provider Name (Legal Business Name): COMPASSIONATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 TAYLOR RD APT 2305
RIVERDALE GA
30274-7101
US

IV. Provider business mailing address

8050 TAYLOR RD APT 2305
RIVERDALE GA
30274-7101
US

V. Phone/Fax

Practice location:
  • Phone: 936-545-6074
  • Fax:
Mailing address:
  • Phone: 936-545-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LEKEYA LEE
Title or Position: OWNER
Credential:
Phone: 936-545-6074