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General NPI Number Information
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NPI Number | 1174449797
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Entity Type | Organization
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Legal Business Name | COMPASSION COMMUNITY RESIDENCE LLC
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 11 FERN OAK CT
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City | MANSFIELD
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State | TX
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Zip | 76063-6265
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Country | US
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Telephone | 817-681-0920
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Fax | 414-755-7676
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Provider Business Mailing Address
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Address Line | 11 FERN OAK CT
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City | MANSFIELD
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State | TX
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Zip | 76063-6265
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Country | US
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Telephone | 817-681-0920
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Fax | 817-681-0920
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Authorized Official
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Title or Position | OWNER
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Name | QIANA MARIE WASHINGTON
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Credential | LVN
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Telephone | 817-681-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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