Provider Demographics
NPI:1477985612
Name:COMPASSIONATE HEARTS HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:COMPASSIONATE HEARTS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANQUAN
Authorized Official - Middle Name:LAKEISHA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-554-9274
Mailing Address - Street 1:4651 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1126
Mailing Address - Country:US
Mailing Address - Phone:904-554-9274
Mailing Address - Fax:
Practice Address - Street 1:4651 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1126
Practice Address - Country:US
Practice Address - Phone:904-554-9274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233056253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care