Healthcare Provider Details

I. General information

NPI: 1780903856
Provider Name (Legal Business Name): COMPASS CORPORATION FOR RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 COLLINGWOOD BLVD
TOLEDO OH
43620-1153
US

IV. Provider business mailing address

2465 COLLINGWOOD BLVD
TOLEDO OH
43620-1153
US

V. Phone/Fax

Practice location:
  • Phone: 419-241-8827
  • Fax: 419-321-6833
Mailing address:
  • Phone: 419-241-8827
  • Fax: 419-321-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number12559
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number12559
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT STOKES
Title or Position: RESIDENT/CEO
Credential: MBA
Phone: 419-241-8827