Healthcare Provider Details

I. General information

NPI: 1063296408
Provider Name (Legal Business Name): COMPASSIONATE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 ELDERBERRY PL
FAIRFAX VA
22033-1214
US

IV. Provider business mailing address

15962 PAYNES FARM DR
HAYMARKET VA
20169-8189
US

V. Phone/Fax

Practice location:
  • Phone: 301-537-8248
  • Fax:
Mailing address:
  • Phone: 301-537-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SYDONIE BONGAM
Title or Position: DIRECTOR
Credential: DNP,PMHNP
Phone: 301-537-8248