MEDICARE: COMPASS CARE COORDINATION AGENCY 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861960163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASS CARE COORDINATION AGENCY LLC

Provider Business Mailing Address
First Line	:	901 N PENN ST UNIT R808
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3192
Country	:	US
Telephone Number	:	484-919-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1637 GRANITE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-1365
Country	:	US
Telephone Number	:	610-624-3283
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DENISE SCHLATTER
Credential	:
Telephone Number	:	484-919-9299

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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