| Compassionate Primary Care Llc | |
|
700 Broadway Ste 136 Westwood NJ 07675-1674 | |
| (551) 265-4342 | |
| Not Available |
| Full Name | Compassionate Primary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 700 Broadway Ste 136, Westwood, New Jersey |
| Authorized Official Name and Position | Lakeisha Nicholls (COO/NP) |
| Authorized Official Contact | 5512654342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Compassionate Primary Care Llc 700 Broadway Ste 136 Westwood NJ 07675-1674 Ph: (551) 265-4342 | Compassionate Primary Care Llc 700 Broadway Ste 136 Westwood NJ 07675-1674 Ph: (551) 265-4342 |
| NPI Number | 1861121774 |
|---|---|
| Provider Enumeration Date | 06/07/2022 |
| Last Update Date | 06/07/2022 |
| Medicare PECOS PAC ID | 2466829957 |
|---|---|
| Medicare Enrollment ID | O20221114002075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861121774 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lakeisha Nicole Nicholls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154407096 PECOS PAC ID: 3375910862 Enrollment ID: I20221123000159 |
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