Healthcare Provider Details

I. General information

NPI: 1659100337
Provider Name (Legal Business Name): COMPASS CENTER FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S MAIN ST STE A
CORONA CA
92882-4455
US

IV. Provider business mailing address

1113 S MAIN ST STE A
CORONA CA
92882-4455
US

V. Phone/Fax

Practice location:
  • Phone: 626-252-4314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSHUA L JJEMBA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 626-252-4314