=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942329453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASSIONATE CARE NURSING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 06/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5411 OLD FREDERICK RD SUITE 6
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21229-2195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-719-0672
-----------------------------------------------------
Fax | 410-719-0673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5411 OLD FREDERICK RD SUITE 6
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21229-2195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-719-0672
-----------------------------------------------------
Fax | 410-719-0673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ROMONA VICTORIA LEWIS
-----------------------------------------------------
Credential | RN BSN
-----------------------------------------------------
Telephone | 410-719-0672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R2420
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------