Provider Demographics
NPI:1538819099
Name:COMPLETE CARE CLINIC
Entity type:Organization
Organization Name:COMPLETE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINAPOLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:312-451-3853
Mailing Address - Street 1:520 N WESTERN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3734
Mailing Address - Country:US
Mailing Address - Phone:312-451-3853
Mailing Address - Fax:
Practice Address - Street 1:484 NW 165TH STREET RD APT 409
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6461
Practice Address - Country:US
Practice Address - Phone:312-451-3853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty