=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801552070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPANION HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2021
-----------------------------------------------------
Last Update Date | 11/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 S CENTRAL EXPY # 100
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-7411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-868-5151
-----------------------------------------------------
Fax | 888-959-3639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2075 PONTCHARTRAIN DR
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75087-6541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-868-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JEMA MANDARI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-868-5151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------