Provider Demographics
NPI:1861121774
Name:COMPASSIONATE PRIMARY CARE LLC
Entity type:Organization
Organization Name:COMPASSIONATE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/NP
Authorized Official - Prefix:
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLLS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:551-265-4342
Mailing Address - Street 1:700 BROADWAY STE 136
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1674
Mailing Address - Country:US
Mailing Address - Phone:551-265-4342
Mailing Address - Fax:
Practice Address - Street 1:700 BROADWAY STE 136
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1674
Practice Address - Country:US
Practice Address - Phone:551-265-4342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care