MEDICARE: COMPASSIONATE CARE HOME HEALTH, INC.

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		CA

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

General Provider Information

NPI Number	:	1992798847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	2235 N LAKE AVE
Second Line	:	SUITE 209
City	:	ALTADENA
State	:	CA
Zip	:	91001-2465
Country	:	US
Telephone Number	:	626-791-3300
Fax Number	:	626-791-5502

Provider Business Practice Location Address
First Line	:	2235 N LAKE AVE
Second Line	:	SUITE 209
City	:	ALTADENA
State	:	CA
Zip	:	91001-2465
Country	:	US
Telephone Number	:	626-791-3300
Fax Number	:	626-791-5502

Authorized Official
Title or Position	:	ADMINISTRATOR/DOPCS
Name	:	LARENDA RENEE MARTIN
Credential	:	RN
Telephone Number	:	626-791-3300

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	08/22/2020

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