Provider Demographics
NPI:1063296408
Name:COMPASSIONATE HOMES LLC
Entity type:Organization
Organization Name:COMPASSIONATE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYDONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONGAM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,PMHNP
Authorized Official - Phone:301-537-8248
Mailing Address - Street 1:15962 PAYNES FARM DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-8189
Mailing Address - Country:US
Mailing Address - Phone:301-537-8248
Mailing Address - Fax:
Practice Address - Street 1:3640 ELDERBERRY PL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1214
Practice Address - Country:US
Practice Address - Phone:301-537-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities