Provider Demographics
NPI:1790490035
Name:COMPASS PROACTIVE HEALTH CARE LLC
Entity Type:Organization
Organization Name:COMPASS PROACTIVE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:541-968-3395
Mailing Address - Street 1:3155 PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-5140
Mailing Address - Country:US
Mailing Address - Phone:541-968-3395
Mailing Address - Fax:
Practice Address - Street 1:1725 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4118
Practice Address - Country:US
Practice Address - Phone:541-968-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty