Healthcare Provider Details

I. General information

NPI: 1114752516
Provider Name (Legal Business Name): LK COMPASS HEALTHCARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10115 HOLLY DR APT M203
EVERETT WA
98204-8761
US

IV. Provider business mailing address

10115 HOLLY DR APT M203
EVERETT WA
98204-8761
US

V. Phone/Fax

Practice location:
  • Phone: 425-399-6821
  • Fax:
Mailing address:
  • Phone: 425-399-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN KIRUNGI
Title or Position: MEMBER
Credential:
Phone: 425-399-6821