Provider Demographics
NPI:1083043392
Name:COMPCARE, INC
Entity type:Organization
Organization Name:COMPCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:BEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-746-7433
Mailing Address - Street 1:150 126TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-5016
Mailing Address - Country:US
Mailing Address - Phone:208-476-3714
Mailing Address - Fax:208-476-5635
Practice Address - Street 1:524 BRYDEN AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4443
Practice Address - Country:US
Practice Address - Phone:208-746-7433
Practice Address - Fax:208-746-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8062057253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8062057Medicaid
IDM8068450Medicaid
ID8075146Medicaid
IDNONEOtherV.A.