Provider Demographics
NPI:1992138952
Name:COMPASSION HOME CARE
Entity type:Organization
Organization Name:COMPASSION HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:STURDIVANT
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-694-2028
Mailing Address - Street 1:122 A NORTH RUTHERFORD STREET
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2131
Mailing Address - Country:US
Mailing Address - Phone:704-694-2028
Mailing Address - Fax:704-694-2031
Practice Address - Street 1:122 A NORTH RUTHERFORD STREET
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2131
Practice Address - Country:US
Practice Address - Phone:704-694-2028
Practice Address - Fax:704-694-2031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASSION HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4017253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419048Medicaid