Healthcare Provider Details

I. General information

NPI: 1245414184
Provider Name (Legal Business Name): COMPASS ADULT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 RIDGEFIELD BLVD SUITE 190
ASHEVILLE NC
28806-6209
US

IV. Provider business mailing address

PO BOX 19649
CHARLOTTE NC
28219-9649
US

V. Phone/Fax

Practice location:
  • Phone: 704-521-4977
  • Fax: 704-521-8541
Mailing address:
  • Phone: 704-521-4977
  • Fax: 704-521-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK BULLARD
Title or Position: CEO
Credential:
Phone: 704-521-4977