Provider Demographics
NPI:1508227141
Name:COMPASSION COMMUNITY PCH LLC
Entity Type:Organization
Organization Name:COMPASSION COMMUNITY PCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELOOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-354-7007
Mailing Address - Street 1:1942 APPLING HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-3723
Mailing Address - Country:US
Mailing Address - Phone:762-354-7007
Mailing Address - Fax:762-354-7007
Practice Address - Street 1:1942 APPLING HARLEM RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-3723
Practice Address - Country:US
Practice Address - Phone:762-354-7007
Practice Address - Fax:762-354-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty