Provider Demographics
NPI:1427459304
Name:COMPASS CONCIERGE HEALTHCARE, LLC
Entity type:Organization
Organization Name:COMPASS CONCIERGE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-210-5243
Mailing Address - Street 1:2606 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4204
Mailing Address - Country:US
Mailing Address - Phone:870-210-5243
Mailing Address - Fax:
Practice Address - Street 1:2606 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4204
Practice Address - Country:US
Practice Address - Phone:870-210-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care