Healthcare Provider Details

I. General information

NPI: 1396136818
Provider Name (Legal Business Name): COMPASSION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 BUCKSKIN RD
OVERGAARD AZ
85933
US

IV. Provider business mailing address

PO BOX 636
OVERGAARD AZ
85933-0636
US

V. Phone/Fax

Practice location:
  • Phone: 928-200-5804
  • Fax:
Mailing address:
  • Phone: 480-622-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number978494
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberD02301413
License Number StateAZ

VIII. Authorized Official

Name: MRS. MARLEANA M IVANOV
Title or Position: CEO
Credential:
Phone: 928-200-5804