=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023452505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE CARE NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2013
-----------------------------------------------------
Last Update Date | 04/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 FORBES CV
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39272-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-257-6879
-----------------------------------------------------
Fax | 769-257-6879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 231 FORBES CV
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39272-9178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-257-6879
-----------------------------------------------------
Fax | 769-257-6879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. CHELYRIA M PALMER
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 601-316-5908
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | P326161
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------