Provider Demographics
NPI:1508519059
Name:A & J COMPASSIONATE CARE, LLC
Entity Type:Organization
Organization Name:A & J COMPASSIONATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-898-3059
Mailing Address - Street 1:1735 JEFFORDS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4560
Mailing Address - Country:US
Mailing Address - Phone:813-898-3059
Mailing Address - Fax:
Practice Address - Street 1:8319 42ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-3946
Practice Address - Country:US
Practice Address - Phone:813-898-3059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101107200Medicaid