MEDICARE: COMPASSION CARE HEALTH CLINIC LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1144044140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CARE HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	38 NE 20TH AVE STE B
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6548
Country	:	US
Telephone Number	:	954-545-1723
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 NE 20TH AVE STE B
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6548
Country	:	US
Telephone Number	:	954-545-1723
Fax Number	:

Authorized Official
Title or Position	:	MANAGER MEMBER
Name	:	JEAN M RUSSELL
Credential	:
Telephone Number	:	954-545-1723

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	11/14/2024

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