MEDICARE: COMPASSIONATE BRIDGED CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	311ZA0620X	Adult Care Home Facility
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396507729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE BRIDGED CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	102 N KROHN PL STE 215
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-1847
Country	:	US
Telephone Number	:	605-951-2814
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 N KROHN PL STE 215
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-1847
Country	:	US
Telephone Number	:	605-951-2814
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	FADUMO AHMED JAMAL BABA
Credential	:	RN
Telephone Number	:	605-951-2814

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	04/12/2024

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