Provider Demographics
NPI:1588922207
Name:COMPASS SUPPORTIVE PALLIATIVE CARE LLC
Entity type:Organization
Organization Name:COMPASS SUPPORTIVE PALLIATIVE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-375-4375
Mailing Address - Street 1:801 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-9402
Mailing Address - Country:US
Mailing Address - Phone:260-375-4375
Mailing Address - Fax:260-375-4377
Practice Address - Street 1:801 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9402
Practice Address - Country:US
Practice Address - Phone:260-375-4375
Practice Address - Fax:260-375-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty