Healthcare Provider Details

I. General information

NPI: 1588922207
Provider Name (Legal Business Name): COMPASS SUPPORTIVE PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HUNTINGTON AVE
WARREN IN
46792-9402
US

IV. Provider business mailing address

801 HUNTINGTON AVE
WARREN IN
46792-9402
US

V. Phone/Fax

Practice location:
  • Phone: 260-375-4375
  • Fax: 260-375-4377
Mailing address:
  • Phone: 260-375-4375
  • Fax: 260-375-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER D LEMMEN
Title or Position: MEMBER
Credential: M.D.
Phone: 260-375-4375