Provider Demographics
NPI:1326345240
Name:CHC-COMPASSIONATE IN-HOME PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:CHC-COMPASSIONATE IN-HOME PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SOBUTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LNHA MHA
Authorized Official - Phone:570-969-7560
Mailing Address - Street 1:214 E DRINKER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2689
Mailing Address - Country:US
Mailing Address - Phone:570-969-7560
Mailing Address - Fax:570-969-2144
Practice Address - Street 1:214 E. DRINKER ST.
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1249
Practice Address - Country:US
Practice Address - Phone:570-969-7560
Practice Address - Fax:570-969-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04310501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA04310501Medicaid