Provider Demographics
NPI:1932642733
Name:COMPASSIONATE CARE LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE LLC
Other - Org Name:FAMILY PREFERENCE HEALTH CARE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-4715
Mailing Address - Street 1:201 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:MO
Mailing Address - Zip Code:63867-8128
Mailing Address - Country:US
Mailing Address - Phone:573-471-1514
Mailing Address - Fax:573-471-1517
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:MO
Practice Address - Zip Code:63867-8128
Practice Address - Country:US
Practice Address - Phone:573-471-1514
Practice Address - Fax:573-471-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty