Provider Demographics
NPI:1467107789
Name:COMPASSIONATE RELEASE CARE LLC
Entity Type:Organization
Organization Name:COMPASSIONATE RELEASE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-750-0844
Mailing Address - Street 1:1722 DOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-5833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:419 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4500
Practice Address - Country:US
Practice Address - Phone:985-750-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care