Healthcare Provider Details

I. General information

NPI: 1841110533
Provider Name (Legal Business Name): PREVAIL CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CLISBY AVE
DEDHAM MA
02026-2114
US

IV. Provider business mailing address

55 CLISBY AVE
DEDHAM MA
02026-2114
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NKECHI NWACHUKWU
Title or Position: OWNER
Credential:
Phone: --