Provider Demographics
NPI:1114785318
Name:COMPASSIONATE CARE AT HOME
Entity Type:Organization
Organization Name:COMPASSIONATE CARE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-313-2344
Mailing Address - Street 1:2550 S RECKER RD APT 149
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5198
Mailing Address - Country:US
Mailing Address - Phone:385-313-2344
Mailing Address - Fax:
Practice Address - Street 1:2550 S RECKER RD APT 149
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5198
Practice Address - Country:US
Practice Address - Phone:385-313-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty