Provider Demographics
NPI:1952578759
Name:COMPASSIONATE IN-HOME CARE LLC
Entity type:Organization
Organization Name:COMPASSIONATE IN-HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-423-0616
Mailing Address - Street 1:37 WHITAKER LANE
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406
Mailing Address - Country:US
Mailing Address - Phone:775-423-0616
Mailing Address - Fax:775-423-0895
Practice Address - Street 1:37 WHITAKER LANE
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406
Practice Address - Country:US
Practice Address - Phone:775-423-0616
Practice Address - Fax:775-423-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005046907Medicaid
NV9005048473OtherMEDICAID WAIVER