=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497212351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPANION SERVICES OF AMERICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2019
-----------------------------------------------------
Last Update Date | 02/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 LAKE COOK RD STE 112
-----------------------------------------------------
City | DEERFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60015-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-948-0860
-----------------------------------------------------
Fax | 847-948-9819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 LAKE COOK RD STE 112
-----------------------------------------------------
City | DEERFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60015-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-948-0860
-----------------------------------------------------
Fax | 847-948-9819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | JAMIE SMITH SHAPIRO
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 847-948-0860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------