Provider Demographics
NPI:1497236327
Name:PROVIDENCE COMPANION CARE
Entity Type:Organization
Organization Name:PROVIDENCE COMPANION CARE
Other - Org Name:PROVIDENCE COMPANION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-801-2040
Mailing Address - Street 1:PO BOX 2047
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-8047
Mailing Address - Country:US
Mailing Address - Phone:662-801-2040
Mailing Address - Fax:662-483-1801
Practice Address - Street 1:317 HERITAGE DR STE 3B
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-0100
Practice Address - Fax:662-483-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care