Provider Demographics
NPI:1942742739
Name:COMPASSIONATE CARE CONSULTANTS, INC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE CONSULTANTS, INC
Other - Org Name:COMPASSIONATE CARE SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS HCA
Authorized Official - Phone:417-623-2447
Mailing Address - Street 1:2914 E 32ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4403
Mailing Address - Country:US
Mailing Address - Phone:417-623-2447
Mailing Address - Fax:417-201-4882
Practice Address - Street 1:1411 E STEVE OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-7915
Practice Address - Country:US
Practice Address - Phone:918-544-6966
Practice Address - Fax:417-201-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8068251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHC8068OtherSTATE OF OKLAHOMA HEALTH DEPARTMENT LICENSE