Provider Demographics
NPI:1376142232
Name:COMPASSIONATE CARE PERSONAL CARE HOME
Entity Type:Organization
Organization Name:COMPASSIONATE CARE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMANIC
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-444-9204
Mailing Address - Street 1:182 RILEY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-0771
Mailing Address - Country:US
Mailing Address - Phone:478-357-2122
Mailing Address - Fax:
Practice Address - Street 1:182 RILEY AVE STE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-0771
Practice Address - Country:US
Practice Address - Phone:478-357-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty