Provider Demographics
NPI:1639499684
Name:A COMPASS IN LIFE
Entity Type:Organization
Organization Name:A COMPASS IN LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, PSYCHOLOGY
Authorized Official - Phone:208-406-7994
Mailing Address - Street 1:2446 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2103
Mailing Address - Country:US
Mailing Address - Phone:208-406-7994
Mailing Address - Fax:
Practice Address - Street 1:2446 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2103
Practice Address - Country:US
Practice Address - Phone:208-406-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management