Provider Demographics
NPI:1629244439
Name:COMPASSION COMMUNITY SERV LLC
Entity Type:Organization
Organization Name:COMPASSION COMMUNITY SERV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-367-5858
Mailing Address - Street 1:PO BOX 11857
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-1857
Mailing Address - Country:US
Mailing Address - Phone:337-367-5858
Mailing Address - Fax:337-364-1081
Practice Address - Street 1:910 E MAIN ST
Practice Address - Street 2:SUITE 23
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-367-5858
Practice Address - Fax:337-364-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA12828372600000X, 3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170496Medicaid