Provider Demographics
NPI:1730920117
Name:PRIMECARE COMPREHENSIVE HEALTH, LLC
Entity type:Organization
Organization Name:PRIMECARE COMPREHENSIVE HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:CHUK KWAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:917-915-8506
Mailing Address - Street 1:220 SILVER BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2384
Mailing Address - Country:US
Mailing Address - Phone:917-915-8506
Mailing Address - Fax:
Practice Address - Street 1:2600 GLASGOW AVE STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5704
Practice Address - Country:US
Practice Address - Phone:302-204-1639
Practice Address - Fax:302-209-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty