MEDICARE: COMPASSIONATE CARE PERSONAL 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	253Z00000X	In Home Supportive Care Agency		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750741849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE PERSONAL SERVICES

Provider Business Mailing Address
First Line	:	330 EDGEWOOD TERRACE DR
Second Line	:	STE B
City	:	JACKSON
State	:	MS
Zip	:	39206-6216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 EDGEWOOD TERRACE DR
Second Line	:	STE B
City	:	JACKSON
State	:	MS
Zip	:	39206-6216
Country	:	US
Telephone Number	:	769-216-2587
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KENNETH L MYRICKS
Credential	:
Telephone Number	:	769-216-2587

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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Directions to “COMPASSIONATE CARE PERSONAL SERVICES ” Practice Location

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