Healthcare Provider Details

I. General information

NPI: 1932512928
Provider Name (Legal Business Name): COMPASS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 MAIN ST STE 2
SPRINGVALE ME
04083-1874
US

IV. Provider business mailing address

PO BOX 403
SPRINGVALE ME
04083-0403
US

V. Phone/Fax

Practice location:
  • Phone: 207-608-9054
  • Fax:
Mailing address:
  • Phone: 207-608-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TARA L MOULTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 207-608-9054