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General NPI Number Information
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NPI Number | 1750741849
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE CARE PERSONAL SERVICES
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 330 EDGEWOOD TERRACE DR STE B
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City | JACKSON
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State | MS
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Zip | 39206-6216
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Country | US
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Telephone | 769-216-2587
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Fax |
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Provider Business Mailing Address
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Address Line | 330 EDGEWOOD TERRACE DR STE B
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City | JACKSON
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State | MS
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Zip | 39206-6216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENNETH L MYRICKS
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Credential |
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Telephone | 769-216-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | MS
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