Provider Demographics
NPI:1780323154
Name:COMPASS CHILDREN'S CLINIC
Entity type:Organization
Organization Name:COMPASS CHILDREN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-986-3069
Mailing Address - Street 1:230 E CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-4002
Mailing Address - Country:US
Mailing Address - Phone:603-986-3069
Mailing Address - Fax:
Practice Address - Street 1:230 E CONWAY RD
Practice Address - Street 2:
Practice Address - City:CENTER CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03813-4002
Practice Address - Country:US
Practice Address - Phone:603-733-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3137575Medicaid