Healthcare Provider Details

I. General information

NPI: 1104647502
Provider Name (Legal Business Name): KJK COMPASSION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 TOWNE LAKE PKWY STE 116232
WOODSTOCK GA
30189-5520
US

IV. Provider business mailing address

2295 TOWNE LAKE PKWY STE 116232
WOODSTOCK GA
30189-5520
US

V. Phone/Fax

Practice location:
  • Phone: 678-907-8522
  • Fax:
Mailing address:
  • Phone: 678-907-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACHIELE HOWARD
Title or Position: MEMBER
Credential:
Phone: 678-907-8522