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NPI Code Detail

MEDICARE: COMPASSION VALLEY LLC

MEDICARE: COMPASSION VALLEY 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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1275178493
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPASSION VALLEY LLC
Provider Business Mailing Address
First Line : 5410 WHITE LOTUS WAY
Second Line :
City : ELK GROVE
State : CA
Zip : 95757-4354
Country : US
Telephone Number : 916-870-9676
Fax Number :
Provider Business Practice Location Address
First Line : 6110 GARFIELD AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-2009
Country : US
Telephone Number : 916-870-9676
Fax Number : 888-870-8642
Authorized Official
Title or Position : CEO
Name : IFEANYI EZEANI
Credential :
Telephone Number : 916-870-9676
Provider Enumeration Date : 11/12/2019
Last Update Date : 10/06/2022

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Directions to “COMPASSION VALLEY LLC ” Practice Location

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