Provider Demographics
NPI:1023268570
Name:COMPASSIONATE CAREGIVER INC
Entity type:Organization
Organization Name:COMPASSIONATE CAREGIVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-398-0734
Mailing Address - Street 1:2217 PERRY PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3465
Mailing Address - Country:US
Mailing Address - Phone:904-398-0734
Mailing Address - Fax:904-398-0734
Practice Address - Street 1:2217 PERRY PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3465
Practice Address - Country:US
Practice Address - Phone:904-398-0734
Practice Address - Fax:904-398-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-21
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL113713104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6930506 96OtherMEDICAID WAVIER PROVIDER