Healthcare Provider Details

I. General information

NPI: 1346870763
Provider Name (Legal Business Name): COMPASSIONATE CARE AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 SCENIC HWY S
SNELLVILLE GA
30078-3115
US

IV. Provider business mailing address

2330 SCENIC HWY S
SNELLVILLE GA
30078-3115
US

V. Phone/Fax

Practice location:
  • Phone: 678-755-8910
  • Fax:
Mailing address:
  • Phone: 678-755-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLARISSE KEHOU
Title or Position: CEO
Credential: LPN
Phone: 678-755-8910