Healthcare Provider Details

I. General information

NPI: 1881991008
Provider Name (Legal Business Name): COMPASS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26182 CAMDEN WOODS DR
FORT MILL SC
29707-6339
US

IV. Provider business mailing address

26182 CAMDEN WOODS DR
FORT MILL SC
29707-6339
US

V. Phone/Fax

Practice location:
  • Phone: 803-720-5590
  • Fax: 803-720-5591
Mailing address:
  • Phone: 803-720-5590
  • Fax: 803-720-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5084
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005158
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. QUIANA MESHELL DIXON
Title or Position: OWNER
Credential:
Phone: 803-720-5590