Healthcare Provider Details

I. General information

NPI: 1801123716
Provider Name (Legal Business Name): COMPASSION HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 RIVERSIDE DR
NORFOLK VA
23502-4351
US

IV. Provider business mailing address

3649 RIVERSIDE DR
NORFOLK VA
23502-4351
US

V. Phone/Fax

Practice location:
  • Phone: 757-923-1937
  • Fax: 757-923-1938
Mailing address:
  • Phone: 757-923-1937
  • Fax: 757-923-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. DANORA BROCKMAN
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 757-923-1937