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General NPI Number Information
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NPI Number | 1396447140
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARES OUTREACH LABORATORY SERVICES LLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1068 MERCHANTS DR APT 416
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City | DALLAS
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State | GA
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Zip | 30132-2969
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Country | US
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Telephone | 470-891-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 1068 MERCHANTS DR APT 416
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City | DALLAS
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State | GA
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Zip | 30132-2969
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Country | US
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Telephone | 470-891-0940
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SABRINA NICOLE SUTTON
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Credential | CCMA
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Telephone | 470-891-0940
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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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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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