Healthcare Provider Details

I. General information

NPI: 1245860576
Provider Name (Legal Business Name): COMPASSION COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5059 HAYES ST
GARY IN
46408-4355
US

IV. Provider business mailing address

5059 HAYES ST
GARY IN
46408-4355
US

V. Phone/Fax

Practice location:
  • Phone: 256-797-1363
  • Fax:
Mailing address:
  • Phone: 256-797-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AQUANATTE JACKSON
Title or Position: CEO
Credential: LCSW
Phone: 256-797-1363