MEDICARE: COMPASSION CARE CENTER

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	261QC1500X	Community Health Clinic/Center	190700AN	CA

General Provider Information

NPI Number	:	1275974420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CARE CENTER

Provider Business Mailing Address
First Line	:	2614 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3057
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-373-9786

Provider Business Practice Location Address
First Line	:	2614 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3057
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-373-9786

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TIM LESTER
Credential	:
Telephone Number	:	310-230-5574

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	07/16/2013

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Directions to “COMPASSION CARE CENTER ” Practice Location

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