MEDICARE: COMPASSIONATE COMPLETE SUPPORT SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1053715623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE COMPLETE SUPPORT SERVICES, INC

Provider Business Mailing Address
First Line	:	1439 8TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3046
Country	:	US
Telephone Number	:	561-727-6234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1439 8TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3046
Country	:	US
Telephone Number	:	561-727-6234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRACEY HUBBARD
Credential	:
Telephone Number	:	561-727-6234

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	10/10/2014

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