Provider Demographics
NPI:1942655683
Name:COMPANION CARE AT HOME, LLC
Entity Type:Organization
Organization Name:COMPANION CARE AT HOME, LLC
Other - Org Name:COMPANION CARE SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-0006
Mailing Address - Street 1:510 BELLEVUE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5368
Mailing Address - Country:US
Mailing Address - Phone:478-275-0006
Mailing Address - Fax:
Practice Address - Street 1:510 BELLEVUE AVE STE B
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5368
Practice Address - Country:US
Practice Address - Phone:478-275-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA087-R-0006253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care