Provider Demographics
NPI:1043017353
Name:COMPASSIONATE CARE DAY SUPPORT LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE DAY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:804-255-6777
Mailing Address - Street 1:700 S SYCAMORE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5804
Mailing Address - Country:US
Mailing Address - Phone:804-255-6777
Mailing Address - Fax:
Practice Address - Street 1:700 S SYCAMORE ST STE 5
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5804
Practice Address - Country:US
Practice Address - Phone:804-255-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty