Healthcare Provider Details

I. General information

NPI: 1114305067
Provider Name (Legal Business Name): COMPANION EXTRAORDINAIRE HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ENGLAND STREET SUITE A
ASHLAND VA
23005
US

IV. Provider business mailing address

P.O. BOX 734 112 ENGLAND STREET SUITE A
ASHLAND VA
23005
US

V. Phone/Fax

Practice location:
  • Phone: 804-752-2205
  • Fax: 804-752-3403
Mailing address:
  • Phone: 804-752-2205
  • Fax: 804-752-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DAWN BENINGHOVE
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 804-752-2205