Provider Demographics
NPI:1265485965
Name:COMPASSIONATE CARE HOME CARE SERVICE INC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE HOME CARE SERVICE INC
Other - Org Name:COMPASSIONATE HOME CARE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEBERAH
Authorized Official - Middle Name:RASHIDAH
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:313-863-2273
Mailing Address - Street 1:11000 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2357
Mailing Address - Country:US
Mailing Address - Phone:313-863-2273
Mailing Address - Fax:313-863-5535
Practice Address - Street 1:11000 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2393
Practice Address - Country:US
Practice Address - Phone:313-863-2273
Practice Address - Fax:313-863-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237650Medicare ID - Type UnspecifiedMEDICARE