Healthcare Provider Details

I. General information

NPI: 1417678210
Provider Name (Legal Business Name): COMPASSION HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 SIX FORKS RD STE 107
RALEIGH NC
27609-4468
US

IV. Provider business mailing address

5306 SIX FORKS RD STE 107
RALEIGH NC
27609-4468
US

V. Phone/Fax

Practice location:
  • Phone: 919-824-6791
  • Fax:
Mailing address:
  • Phone: 919-824-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TONYA HICKS
Title or Position: OWNER
Credential:
Phone: 919-866-2928