Provider Demographics
NPI:1861000499
Name:COMPASSIONATE HEALTH SERVICES
Entity Type:Organization
Organization Name:COMPASSIONATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYOKUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-460-8801
Mailing Address - Street 1:6720 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7762
Mailing Address - Country:US
Mailing Address - Phone:317-460-8801
Mailing Address - Fax:574-975-4155
Practice Address - Street 1:5812 W HILLS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6358
Practice Address - Country:US
Practice Address - Phone:317-460-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN014921Medicaid