MEDICARE: COMPADRES THERAPY, INC.

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1235578048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPADRES THERAPY, INC.

Provider Business Mailing Address
First Line	:	3800 N MESA ST
Second Line	:	SUITE A2
City	:	EL PASO
State	:	TX
Zip	:	79902-1538
Country	:	US
Telephone Number	:	915-203-0885
Fax Number	:	915-545-2697

Provider Business Practice Location Address
First Line	:	6666 MORRILL RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-2608
Country	:	US
Telephone Number	:	915-203-0885
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. JOY E FERGUSON
Credential	:
Telephone Number	:	915-203-0885

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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