Provider Demographics
NPI:1437636818
Name:COMPASSIONATE HOMES & MEDICAL SUPPLIES SERVICES CORP
Entity Type:Organization
Organization Name:COMPASSIONATE HOMES & MEDICAL SUPPLIES SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADESANYA
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:904-551-0465
Mailing Address - Street 1:3419 GLENN HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2352
Mailing Address - Country:US
Mailing Address - Phone:904-551-0465
Mailing Address - Fax:904-551-0465
Practice Address - Street 1:6730 GOLDENEYE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6088
Practice Address - Country:US
Practice Address - Phone:904-551-0465
Practice Address - Fax:904-551-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities