Healthcare Provider Details

I. General information

NPI: 1891324471
Provider Name (Legal Business Name): COMPCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-997 HANAUNA ST 5F
WAIPAHU HI
96797
US

IV. Provider business mailing address

1130 SCHWALL ROAD
HAVANA FL
32333
US

V. Phone/Fax

Practice location:
  • Phone: 850-694-9864
  • Fax: 850-270-2452
Mailing address:
  • Phone: 850-694-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ORETHA DIANE JONES
Title or Position: OWNER/CEO/ARNP
Credential: ARNP
Phone: 850-694-9864