Provider Demographics
NPI:1144687971
Name:TOMM'S COMPASSIONATE CARE
Entity type:Organization
Organization Name:TOMM'S COMPASSIONATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GMA
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-515-0669
Mailing Address - Street 1:2061 KAUMANA AVE.
Mailing Address - Street 2:AVENUE
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:650-839-3968
Mailing Address - Fax:
Practice Address - Street 1:2061 KAUMANA DR
Practice Address - Street 2:AVENUE
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-1414
Practice Address - Country:US
Practice Address - Phone:650-839-3968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care