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General NPI Number Information
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NPI Number | 1003438748
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE PROFESSIONAL HOME CARE, LLC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 527 US HIGHWAY 80 W # C102
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City | GARDEN CITY
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State | GA
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Zip | 31408-3115
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Country | US
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Telephone | 912-677-2143
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Fax |
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Provider Business Mailing Address
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Address Line | 527 US HIGHWAY 80 W # C102
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City | GARDEN CITY
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State | GA
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Zip | 31408-3115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATRISSE DAVIS
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Credential |
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Telephone | 912-677-2143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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