Healthcare Provider Details

I. General information

NPI: 1629325964
Provider Name (Legal Business Name): COMPASSIONATE CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 JACKSON ST
HAZLEHURST MS
39083-2113
US

IV. Provider business mailing address

323 JACKSON ST
HAZLEHURST MS
39083-2113
US

V. Phone/Fax

Practice location:
  • Phone: 601-500-0027
  • Fax: 601-894-6577
Mailing address:
  • Phone: 601-500-0027
  • Fax: 601-894-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number05603243
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number02089343
License Number StateMS

VIII. Authorized Official

Name: MRS. TWANNA L BYTHER
Title or Position: OWNER
Credential:
Phone: 601-500-0027