Provider Demographics
NPI:1861126963
Name:SOUTHERN COMPASSION HOME CARE LLC
Entity type:Organization
Organization Name:SOUTHERN COMPASSION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYUNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-652-5646
Mailing Address - Street 1:3343 PEACHTREE RD NE STE 145-668
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1085
Mailing Address - Country:US
Mailing Address - Phone:770-652-5646
Mailing Address - Fax:
Practice Address - Street 1:935 RING NECKED CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4475
Practice Address - Country:US
Practice Address - Phone:770-652-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care