Provider Demographics
NPI:1902534274
Name:COMPASSION-FIRST GROUP HOME LLC
Entity Type:Organization
Organization Name:COMPASSION-FIRST GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-721-0438
Mailing Address - Street 1:8014 CHANTILLY MNR
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-2362
Mailing Address - Country:US
Mailing Address - Phone:310-721-0438
Mailing Address - Fax:
Practice Address - Street 1:8014 CHANTILLY MNR
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-2362
Practice Address - Country:US
Practice Address - Phone:310-721-0438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities