Provider Demographics
NPI:1154595262
Name:COMPANIONSHIP HOME CARE, INC
Entity type:Organization
Organization Name:COMPANIONSHIP HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JONGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-270-9990
Mailing Address - Street 1:8740 N KENDALL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2212
Mailing Address - Country:US
Mailing Address - Phone:305-270-9990
Mailing Address - Fax:305-270-9960
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:305-270-9990
Practice Address - Fax:305-270-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993044251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109266Medicare PIN