Healthcare Provider Details

I. General information

NPI: 1942634399
Provider Name (Legal Business Name): COMPASSIONATE CARE ADVANTAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 JONES AVE
DORCHESTER MA
02124-4128
US

IV. Provider business mailing address

50 JONES AVE
DORCHESTER MA
02124-4128
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-8617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIA SALMON
Title or Position: OWNER
Credential:
Phone: 617-318-8617