Provider Demographics
NPI:1053681916
Name:COMPASSIONATE HOMEMAKER AND RESPITE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE HOMEMAKER AND RESPITE CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-845-6651
Mailing Address - Street 1:475 MCLIN CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-7939
Mailing Address - Country:US
Mailing Address - Phone:601-845-6651
Mailing Address - Fax:601-845-0230
Practice Address - Street 1:475 MCLIN CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-7939
Practice Address - Country:US
Practice Address - Phone:601-845-6651
Practice Address - Fax:601-845-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04129817Medicaid
MS08700721Medicaid