Healthcare Provider Details

I. General information

NPI: 1982446696
Provider Name (Legal Business Name): COMPASSIONATE CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 E STATE BLVD
FORT WAYNE IN
46815-7762
US

IV. Provider business mailing address

6720 E STATE BLVD
FORT WAYNE IN
46815-7762
US

V. Phone/Fax

Practice location:
  • Phone: 317-460-8801
  • Fax: 574-975-4155
Mailing address:
  • Phone: 317-460-8801
  • Fax: 574-975-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS MAYOKUN ADEYALE
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-460-8801