Healthcare Provider Details

I. General information

NPI: 1528994191
Provider Name (Legal Business Name): COMMUNITY CARE INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4618 BEDFORD AVE
BROOKLYN NY
11235-2612
US

IV. Provider business mailing address

4618 BEDFORD AVE
BROOKLYN NY
11235-2612
US

V. Phone/Fax

Practice location:
  • Phone: 646-591-7971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: VENUS MARTIN
Title or Position: REGISTERED NURSE
Credential:
Phone: 646-591-7971