Healthcare Provider Details

I. General information

NPI: 1386309128
Provider Name (Legal Business Name): COMPASSIONATE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 COUNTY ROAD 10 STE 5518D
BROOKLYN CENTER MN
55429-3072
US

IV. Provider business mailing address

3300 COUNTY ROAD 10 STE 5518D
BROOKLYN CENTER MN
55429-3072
US

V. Phone/Fax

Practice location:
  • Phone: 612-598-7615
  • Fax:
Mailing address:
  • Phone: 612-598-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTUS G. WRAYEE
Title or Position: OWNER
Credential:
Phone: 612-598-7615