Healthcare Provider Details

I. General information

NPI: 1184165862
Provider Name (Legal Business Name): COMPASSIONATE HEALTH AND MANAGED PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W GRANADA BLVD STE 2
ORMOND BEACH FL
32174-8104
US

IV. Provider business mailing address

1414 W GRANADA BLVD STE 2
ORMOND BEACH FL
32174-8104
US

V. Phone/Fax

Practice location:
  • Phone: 386-451-2346
  • Fax:
Mailing address:
  • Phone: 386-451-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME101968
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TISH J BROWN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 386-944-9813