Provider Demographics
NPI:1114494879
Name:COMPASSIONATE NURSING TOUCH
Entity Type:Organization
Organization Name:COMPASSIONATE NURSING TOUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-996-1429
Mailing Address - Street 1:30 CARRIAGE PARKE DR
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-6052
Mailing Address - Country:US
Mailing Address - Phone:601-996-1429
Mailing Address - Fax:
Practice Address - Street 1:30 CARRIAGE PARKE DR
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-6052
Practice Address - Country:US
Practice Address - Phone:601-996-1429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1159771OtherSECRETARY OF STATE