1134306293 NPI number — ROCK VALLEY COMMUNITY PROGRAMS, INC.

Table of content: (NPI 1134306293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134306293 NPI number — ROCK VALLEY COMMUNITY PROGRAMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCK VALLEY COMMUNITY PROGRAMS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPASS BEHAVIORAL HEALTH CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134306293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 W. SUNNY LANE ROAD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JANESVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53546-9091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-741-4500
Provider Business Mailing Address Fax Number:
608-741-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1820 CENTER AVE STE 170
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53546-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-755-1475
Provider Business Practice Location Address Fax Number:
608-755-1733
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
SHAMEEKA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
608-741-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1809 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 1809 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42247900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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