MEDICARE: COMPASSION CARE CENTER

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	7458	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19748	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1811234578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSION CARE CENTER

Provider Business Mailing Address
First Line	:	2614 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-3057
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-373-9786

Provider Business Practice Location Address
First Line	:	2606 N CENTRAL AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90222-1640
Country	:	US
Telephone Number	:	310-230-5574
Fax Number	:	323-373-9786

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TIMOTHY ALEXANDER LESTER JR.
Credential	:
Telephone Number	:	310-230-5574

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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Directions to “COMPASSION CARE CENTER ” Practice Location

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