Provider Demographics
NPI:1881165504
Name:COMPASSIONATE CONNECTIONS HOME CARE LLC
Entity type:Organization
Organization Name:COMPASSIONATE CONNECTIONS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASIA
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:DRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-511-8911
Mailing Address - Street 1:32 E MAGNOLIA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3482
Mailing Address - Country:US
Mailing Address - Phone:866-511-8911
Mailing Address - Fax:407-550-8031
Practice Address - Street 1:32 E MAGNOLIA AVE UNIT A
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3482
Practice Address - Country:US
Practice Address - Phone:866-511-8911
Practice Address - Fax:407-550-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30212393OtherAHCA
FL104222600Medicaid