Healthcare Provider Details

I. General information

NPI: 1861618308
Provider Name (Legal Business Name): COMPASS HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-8310
  • Fax:
Mailing address:
  • Phone: 660-890-8186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. TERESA PORTER
Title or Position: CREDENTIALING/CONTRACTING MANAGER
Credential:
Phone: 660-890-8186