Provider Demographics
NPI:1386000107
Name:COMPASSIONATE HEARTS LLC
Entity Type:Organization
Organization Name:COMPASSIONATE HEARTS LLC
Other - Org Name:GEM HOUSE SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-668-1485
Mailing Address - Street 1:7432 W GLENROSA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-2518
Mailing Address - Country:US
Mailing Address - Phone:623-399-9280
Mailing Address - Fax:623-455-5186
Practice Address - Street 1:7432 W GLENROSA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-2518
Practice Address - Country:US
Practice Address - Phone:623-399-9280
Practice Address - Fax:623-455-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ530097Medicaid