Provider Demographics
NPI:1972668150
Name:COMPASSIONATE CARE ADULT DAY CARE
Entity type:Organization
Organization Name:COMPASSIONATE CARE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-686-8123
Mailing Address - Street 1:1600 BRECKENRIDGE ST
Mailing Address - Street 2:P.O. BOX 309
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1055
Mailing Address - Country:US
Mailing Address - Phone:270-686-8123
Mailing Address - Fax:
Practice Address - Street 1:1601 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1056
Practice Address - Country:US
Practice Address - Phone:270-686-8123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREEN RIVER DISTRICT HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750047261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY43010305Medicaid