NPIMap

Organization Active NPI

Compass Behavioral Center of Houma, LLC

  • Psychiatric Hospital
  • Houma, LA
National Provider Identifier
1497015622
Registry record updated Jul 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
COMPASS BEHAVIORAL CENTER OF HOUMA, LLC
Practice address
4701 W Park Ave
Houma, LA 70364
Phone
(985) 223-6269
Fax
(985) 223-0162
NPI assigned
May 22, 2012
Last updated
Jul 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark J Cullen
Title
Ceo
Phone
(337) 788-3330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X LA Primary

Addresses

Primary practice location

4701 W Park Ave
Houma, LA 70364

Mailing address

4701 W Park Ave
Houma, LA 70364
Phone (985) 223-6269

Other names 1

  • Compass Psychiatric Specialties Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120716000338 LA Part A Provider - Hospital 9133184492 Practice locations: Houma, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497015622. Details of each certification follow.

Hospital certification: CCN 194109

Legal name
COMPASS BEHAVIORAL CENTER OF HOUMA, LLC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Sep 21, 2012
Last certification
Sep 21, 2022
Beds
20
Ownership / control type
Private (for profit)
Most recent change of ownership
Dec 31, 2017 (1 total)
Organization structure
CorporationProprietary
Incorporated
Dec 5, 2002 in LA
Enrollment address
4701W Park Ave
Houma, LA 70364-4426
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Compass Behavioral Center of Houma, LLCCCN 194109 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2041658Compass Behavioral Center of Houma, Inc4701 West Park Avenue, Houma, LA 70364Certificate of waiverMay 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Compass Behavioral Center of Houma LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4701 W Park Ave
Houma, LA 70364
Phone (985) 223-0161

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cullen Holdings LLC Organization, Crowley, LA LLC 5% Or Greater Direct Ownership Interest Dec 31, 2015 100%
Joni Tabor Individual Corporate OfficerChief Financial Officer Dec 31, 2015
W-2 Managing Employee Dec 31, 2015
Lynn F Cullen Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2015 10%
Mark J Cullen Individual 5% Or Greater Indirect Ownership Interest Feb 4, 2021 71%
Corporate OfficerChief Executive Officer Dec 31, 2015

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532304000000",
    "number": "1497015622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 W PARK AVE",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "70364",
            "telephone_number": "985-223-6269",
            "fax_number": "985-223-0162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 W PARK AVE",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "70364",
            "telephone_number": "985-223-6269",
            "fax_number": "985-223-0162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASS BEHAVIORAL CENTER OF HOUMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2018-07-23",
        "status": "A",
        "authorized_official_last_name": "CULLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-788-3330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Compass Psychiatric Specialties",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Compass Psychiatric Specialties",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Houma, LA

Sources for this page

Verify at the official NPI Registry.