Provider Demographics
NPI:1629617477
Name:COMPASS BRIDGES LLC
Entity Type:Organization
Organization Name:COMPASS BRIDGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-703-2900
Mailing Address - Street 1:142 GRANT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5222
Mailing Address - Country:US
Mailing Address - Phone:904-703-2900
Mailing Address - Fax:
Practice Address - Street 1:14 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7420
Practice Address - Country:US
Practice Address - Phone:904-703-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities