MEDICARE: COMPASSION CARE ASSISTED LIVING 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	:	1578188744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CARE ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	535 BETTON ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45214-2709
Country	:	US
Telephone Number	:	513-402-2670
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 BETTON ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45214-2709
Country	:	US
Telephone Number	:	513-402-2670
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FATIMA JOHNSON
Credential	:
Telephone Number	:	513-439-4521

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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