=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881941037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSION HEALTH SOURCE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2012
-----------------------------------------------------
Last Update Date | 08/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5514 ALMA LN STE 101
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-4014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-992-7914
-----------------------------------------------------
Fax | 703-992-7913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5514 ALMA LN STE 101
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22151-4014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-992-7914
-----------------------------------------------------
Fax | 703-992-7913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ADMINISTRATOR
-----------------------------------------------------
Name | LUCILE W TIONGSON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 703-992-7914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-13841
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------