Provider Demographics
NPI:1073050258
Name:COMPASSIONATE HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMPASSIONATE HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ITHREAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-757-5368
Mailing Address - Street 1:PO BOX 53341
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46253-0341
Mailing Address - Country:US
Mailing Address - Phone:317-757-5368
Mailing Address - Fax:
Practice Address - Street 1:5455 W 86TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1536
Practice Address - Country:US
Practice Address - Phone:317-757-5368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17-014114-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health