Healthcare Provider Details

I. General information

NPI: 1740932151
Provider Name (Legal Business Name): COMPASSIONATE COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6264 GREENVIEW DR
BURTON MI
48509-1361
US

IV. Provider business mailing address

6264 GREENVIEW DR
BURTON MI
48509-1361
US

V. Phone/Fax

Practice location:
  • Phone: 810-962-6196
  • Fax:
Mailing address:
  • Phone: 810-962-6196
  • 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 Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SURRETTA SHIELDS
Title or Position: OWNER
Credential:
Phone: 810-962-6196