1437673027 NPI number — COURAGE COMPASS THERAPY

Table of content: (NPI 1437673027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437673027 NPI number — COURAGE COMPASS THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURAGE COMPASS THERAPY
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:
Provider Other Organization Name Type Code:
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:
1437673027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 IVYSTREAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19040-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-500-7470
Provider Business Mailing Address Fax Number:
844-520-6984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 EASTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-209-0795
Provider Business Practice Location Address Fax Number:
844-520-6984
Provider Enumeration Date:
07/26/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SURNITSKY
Authorized Official First Name:
ANYA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
215-500-7470

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW017160 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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