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General NPI Number Information
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NPI Number | 1134821416
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Entity Type | Organization
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Legal Business Name | CARE COMPANION AT HOME LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 225 GENERAL ROBERT E BLOUNT DRIVE
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City | BASSFIELD
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State | MS
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Zip | 39421
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Country | US
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Telephone | 601-606-0784
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Fax |
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Provider Business Mailing Address
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Address Line | 16B HEARTWOOD PL
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City | HATTIESBURG
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State | MS
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Zip | 39402-9088
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Country | US
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Telephone | 601-549-2135
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KENLEY PAYNE
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Credential |
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Telephone | 601-549-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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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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