Healthcare Provider Details

I. General information

NPI: 1013214394
Provider Name (Legal Business Name): COMPASS FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 CAMINO DEL RIO S SUITE # 106
SAN DIEGO CA
92108-3510
US

IV. Provider business mailing address

444 CAMINO DEL RIO S SUITE # 106
SAN DIEGO CA
92108-3510
US

V. Phone/Fax

Practice location:
  • Phone: 619-446-6936
  • Fax: 619-446-6532
Mailing address:
  • Phone: 619-446-6936
  • Fax: 619-446-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY J BAKER-ERICZEN
Title or Position: DIRECTOR, INTRICATE MIND INSTITUTE
Credential: PH.D.
Phone: 616-446-6936