Healthcare Provider Details

I. General information

NPI: 1902680358
Provider Name (Legal Business Name): COMPASS HEALTH CENTER VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11941 BOURNEFIELD WAY
SILVER SPRING MD
20904-7821
US

IV. Provider business mailing address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax: 224-306-1878
Mailing address:
  • Phone: 224-306-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID SCHREIBER
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 224-306-1879