=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003497991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2021
-----------------------------------------------------
Last Update Date | 04/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2326 GODDARD PKWY UNIT A
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-978-7803
-----------------------------------------------------
Fax | 443-978-7827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2326 GODDARD PKWY STE A
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-978-7803
-----------------------------------------------------
Fax | 443-978-7827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GROWTH & HR MANAGER
-----------------------------------------------------
Name | SIMILOLUWA OJURI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 667-239-3144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------