Provider Demographics
NPI:1295981629
Name:COMPASS ADULT CARE, INC
Entity type:Organization
Organization Name:COMPASS ADULT CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAI
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:828-670-7723
Mailing Address - Street 1:PO BOX 19649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9649
Mailing Address - Country:US
Mailing Address - Phone:704-521-4977
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-6209
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X, 103T00000X, 103TA0400X, 103TC0700X, 103TP0016X, 103TR0400X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300825Medicaid