Healthcare Provider Details

I. General information

NPI: 1053109223
Provider Name (Legal Business Name): JOHNSON COMPASSIONATE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19119 COLLINSON AVE
EASTPOINTE MI
48021-4709
US

IV. Provider business mailing address

19119 COLLINSON AVE
EASTPOINTE MI
48021-4709
US

V. Phone/Fax

Practice location:
  • Phone: 313-333-8839
  • Fax:
Mailing address:
  • Phone: 901-582-1692
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RANDONA JOHNSON
Title or Position: MEMBER
Credential:
Phone: 901-582-1692