Provider Demographics
NPI:1760450563
Name:COMPASS RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:COMPASS RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:330-298-9391
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3101
Mailing Address - Country:US
Mailing Address - Phone:330-298-9391
Mailing Address - Fax:330-298-9392
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3101
Practice Address - Country:US
Practice Address - Phone:330-298-9391
Practice Address - Fax:330-298-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12399101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12399Medicare UPIN