Healthcare Provider Details

I. General information

NPI: 1932784113
Provider Name (Legal Business Name): COMPASSIONATE ADVOCATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28475 GREENFIELD RD STE 113-1508
SOUTHFIELD MI
48076-3034
US

IV. Provider business mailing address

28475 GREENFIELD RD STE 113-1508
SOUTHFIELD MI
48076-3034
US

V. Phone/Fax

Practice location:
  • Phone: 833-522-2625
  • Fax:
Mailing address:
  • Phone: 833-522-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN STALLWORTH
Title or Position: OWNER
Credential:
Phone: 248-392-7616