Basic Information
Provider Information | |||||||||
NPI: | 1396733887 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMPASS HEALTH INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ARROYO GRANDE CARE CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1212 FARROLL AVE | ||||||||
Address2: |   | ||||||||
City: | ARROYO GRANDE | ||||||||
State: | CA | ||||||||
PostalCode: | 934203718 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8054898137 | ||||||||
FaxNumber: | 8054811534 | ||||||||
Practice Location | |||||||||
Address1: | 1212 FARROLL AVE | ||||||||
Address2: |   | ||||||||
City: | ARROYO GRANDE | ||||||||
State: | CA | ||||||||
PostalCode: | 934203718 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8054898137 | ||||||||
FaxNumber: | 8054811534 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MOYA | ||||||||
AuthorizedOfficialFirstName: | MARIE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
AuthorizedOfficialTelephone: | 8054747010 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   | CA | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | LTC05384G | 05 | CA |   | MEDICAID |