=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952887903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPANION CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2018
-----------------------------------------------------
Last Update Date | 07/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1455 EL CAMINO REAL
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94002-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-993-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1455 EL CAMINO REAL
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94002-3909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-993-2345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | BOBBIE JO KEATING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-993-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 414700029
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------