Provider Demographics
NPI:1437413580
Name:COMPASS BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:COMPASS BEHAVIORAL CENTER LLC
Other - Org Name:COMPASS BEHAVIORAL CENTER OF MAMOU
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-788-3330
Mailing Address - Street 1:1510 NAPOLEON ST
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2320
Mailing Address - Country:US
Mailing Address - Phone:337-468-2333
Mailing Address - Fax:337-468-3620
Practice Address - Street 1:1510 NAPOLEON ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2320
Practice Address - Country:US
Practice Address - Phone:337-468-2333
Practice Address - Fax:337-468-3620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS BEHAVIORAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1704351Medicaid
LA1704351Medicaid