Basic Information
| Provider Information | |||||||||
| NPI: | 1780903856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPASS CORPORATION FOR RECOVERY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2465 COLLINGWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436201153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192418827 | ||||||||
| FaxNumber: | 4193216833 | ||||||||
| Practice Location | |||||||||
| Address1: | 2465 COLLINGWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436201153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192418827 | ||||||||
| FaxNumber: | 4193216833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4192418827 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 12559 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207QA0401X | 12559 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.