Provider Demographics
NPI:1922558287
Name:COMPASSUS OP OF CALIFORNIA LLC
Entity Type:Organization
Organization Name:COMPASSUS OP OF CALIFORNIA LLC
Other - Org Name:COMPASSUS - SANTA ANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-224-8028
Mailing Address - Street 1:3110 W LAKE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6917
Mailing Address - Country:US
Mailing Address - Phone:714-445-0407
Mailing Address - Fax:855-212-0422
Practice Address - Street 1:3110 W LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6917
Practice Address - Country:US
Practice Address - Phone:714-445-0407
Practice Address - Fax:855-212-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
551633Medicare Oscar/Certification