=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861711848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPASS CASE MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2010
-----------------------------------------------------
Last Update Date | 05/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 TRAPPERS PATH
-----------------------------------------------------
City | WADING RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11792-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-408-8776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 TRAPPERS PATH
-----------------------------------------------------
City | WADING RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11792-9509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-408-8776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICE
-----------------------------------------------------
Name | MS. ROSELLE ALLISON ZUTT
-----------------------------------------------------
Credential | BA, MHA
-----------------------------------------------------
Telephone | 347-408-8776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------