MEDICARE: COMPASS SENIOR CARE HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164410288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS SENIOR CARE HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	1 HOSPITAL DR
Second Line	:	SUITE 201
City	:	JENNINGS
State	:	LA
Zip	:	70546-3641
Country	:	US
Telephone Number	:	337-824-1558
Fax Number	:	337-824-1561

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:	SUITE 201
City	:	JENNINGS
State	:	LA
Zip	:	70546-3641
Country	:	US
Telephone Number	:	337-824-1558
Fax Number	:	337-824-1561

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RUSTY PHILLIPS
Credential	:	LCSW
Telephone Number	:	337-824-1558

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/25/2020

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