Provider Demographics
NPI:1538238621
Name:COMPASS VIDA LIBRE
Entity type:Organization
Organization Name:COMPASS VIDA LIBRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-882-5608
Mailing Address - Street 1:2475 N JACKRABBIT AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1208
Mailing Address - Country:US
Mailing Address - Phone:520-882-5608
Mailing Address - Fax:
Practice Address - Street 1:2950 N DODGE BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2012
Practice Address - Country:US
Practice Address - Phone:520-624-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ592594Medicaid