Healthcare Provider Details

I. General information

NPI: 1992199780
Provider Name (Legal Business Name): COMPASS HOME CARE AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LOCKART PLZ
PHILADELPHIA PA
19116-3128
US

IV. Provider business mailing address

112 LOCKART PLZ
PHILADELPHIA PA
19116-3128
US

V. Phone/Fax

Practice location:
  • Phone: 267-243-0614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDRIY PUPIN
Title or Position: OWNER
Credential:
Phone: 267-243-0614