Healthcare Provider Details

I. General information

NPI: 1396507729
Provider Name (Legal Business Name): COMPASSIONATE BRIDGED CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N KROHN PL STE 215
SIOUX FALLS SD
57103-1847
US

IV. Provider business mailing address

102 N KROHN PL STE 215
SIOUX FALLS SD
57103-1847
US

V. Phone/Fax

Practice location:
  • Phone: 605-951-2814
  • Fax:
Mailing address:
  • Phone: 605-951-2814
  • 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 Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FADUMO AHMED JAMAL BABA
Title or Position: CO OWNER
Credential: RN
Phone: 605-951-2814