Healthcare Provider Details

I. General information

NPI: 1114681434
Provider Name (Legal Business Name): COMPASS LIFE RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N 1ST ST
INDIANOLA IA
50125-3703
US

IV. Provider business mailing address

1001 SE DELAWARE AVE APT A
ANKENY IA
50021-6517
US

V. Phone/Fax

Practice location:
  • Phone: 515-306-3423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLE GRIMM
Title or Position: CEO
Credential: LMHC
Phone: 515-306-3423