Healthcare Provider Details

I. General information

NPI: 1770768640
Provider Name (Legal Business Name): COMPASS ADULT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SHIPYARD BLVD SUITE 130
WILMINGTON NC
28403-6192
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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