Provider Demographics
NPI:1164410288
Name:COMPASS SENIOR CARE HOSPITAL, LLC
Entity Type:Organization
Organization Name:COMPASS SENIOR CARE HOSPITAL, LLC
Other - Org Name:COMPASS SENIOR CARE HOSPITAL, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-824-1558
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3641
Mailing Address - Country:US
Mailing Address - Phone:337-824-1558
Mailing Address - Fax:337-824-1561
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3641
Practice Address - Country:US
Practice Address - Phone:337-824-1558
Practice Address - Fax:337-824-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1709590Medicaid
LA1709590Medicaid