Provider Demographics
NPI:1316463268
Name:COMPSERV HEALTH RESOURCES INCORPORATED
Entity type:Organization
Organization Name:COMPSERV HEALTH RESOURCES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-506-3400
Mailing Address - Street 1:101 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2924
Mailing Address - Country:US
Mailing Address - Phone:502-561-3464
Mailing Address - Fax:
Practice Address - Street 1:101 N 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2924
Practice Address - Country:US
Practice Address - Phone:502-561-3464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY800254Medicaid