Provider Demographics
NPI:1811569106
Name:BLACK, EUGENIA (OWNER)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:COMPASSION
Other - Middle Name:EXPERTS
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER
Mailing Address - Street 1:51541 BITTERSWEET RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4987
Mailing Address - Country:US
Mailing Address - Phone:574-400-7270
Mailing Address - Fax:574-222-2658
Practice Address - Street 1:51541 BITTERSWEET RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4987
Practice Address - Country:US
Practice Address - Phone:574-400-7270
Practice Address - Fax:574-222-2658
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05Medicaid