Provider Demographics
NPI:1013214394
Name:COMPASS FAMILY CENTER
Entity Type:Organization
Organization Name:COMPASS FAMILY CENTER
Other - Org Name:INTRICATE MIND INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, INTRICATE MIND INSTITUTE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER-ERICZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-446-6936
Mailing Address - Street 1:444 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3510
Mailing Address - Country:US
Mailing Address - Phone:619-446-6936
Mailing Address - Fax:619-446-6532
Practice Address - Street 1:444 CAMINO DEL RIO S
Practice Address - Street 2:SUITE # 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3510
Practice Address - Country:US
Practice Address - Phone:619-446-6936
Practice Address - Fax:619-446-6532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health