Healthcare Provider Details

I. General information

NPI: 1316516768
Provider Name (Legal Business Name): COMPLETE HEALTH PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD STE 309
WARWICK RI
02886-4463
US

IV. Provider business mailing address

1150 RESERVOIR AVE STE 203
CRANSTON RI
02920-6043
US

V. Phone/Fax

Practice location:
  • Phone: 401-259-0340
  • Fax:
Mailing address:
  • Phone: 401-259-0340
  • Fax: 401-213-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY HILLIS
Title or Position: OWNER
Credential: MHC
Phone: 401-259-0340