MEDICARE: COMPASS CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1386107845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS CARE LLC

Provider Business Mailing Address
First Line	:	1607 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:	267-736-0373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 E MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1208
Country	:	US
Telephone Number	:	267-736-0373
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MIA MARSHALL
Credential	:
Telephone Number	:	215-989-0642

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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