=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609178490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE CARE HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 11/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 MASSACHUSETTS AVE
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-664-6611
-----------------------------------------------------
Fax | 413-664-6610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 MASSACHUSETTS AVE
-----------------------------------------------------
City | NORTH ADAMS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01247-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-664-6611
-----------------------------------------------------
Fax | 413-664-6610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCES
-----------------------------------------------------
Name | STEPHANIE HOWLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-664-6611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7485
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------