MEDICARE: COMPASSIONATE CARE SENIOR SERVICES

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1720261795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE SENIOR SERVICES

Provider Business Mailing Address
First Line	:	8075 MALL PKWY
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-6993
Country	:	US
Telephone Number	:	770-617-5259
Fax Number	:

Provider Business Practice Location Address
First Line	:	8075 MALL PKWY
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30038-6993
Country	:	US
Telephone Number	:	770-617-5259
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VERMELL JORDAN
Credential	:
Telephone Number	:	770-617-5259

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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Directions to “COMPASSIONATE CARE SENIOR SERVICES ” Practice Location

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