Basic Information
Provider Information | |||||||||
NPI: | 1982242459 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMPASSIONATE CARE HOSPICE OF MIAMI DADE AND THE FLORIDA KEYS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3854 AMERICAN WAY STE A | ||||||||
Address2: |   | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708164897 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252922031 | ||||||||
FaxNumber: | 7868003603 | ||||||||
Practice Location | |||||||||
Address1: | 460-464 WEST 51ST PLACE | ||||||||
Address2: |   | ||||||||
City: | HIALEAH | ||||||||
State: | FL | ||||||||
PostalCode: | 330123620 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7863294035 | ||||||||
FaxNumber: | 7868003603 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/16/2019 | ||||||||
LastUpdateDate: | 04/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GOFF | ||||||||
AuthorizedOfficialFirstName: | PATRICIA | ||||||||
AuthorizedOfficialMiddleName: | U. | ||||||||
AuthorizedOfficialTitleorPosition: | DELEGATED OFFICIAL | ||||||||
AuthorizedOfficialTelephone: | 2252993701 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |   |
No ID Information.