=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477743367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2007
-----------------------------------------------------
Last Update Date | 03/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14818 COUNTY ROAD 4
-----------------------------------------------------
City | GREENBUSH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-782-4146
-----------------------------------------------------
Fax | 218-782-4191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14818 COUNTY ROAD 4
-----------------------------------------------------
City | GREENBUSH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-782-4146
-----------------------------------------------------
Fax | 218-782-4191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SARA M EEG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-782-4191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | R 143136-4
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7855
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------