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General NPI Number Information
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NPI Number | 1891324471
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Entity Type | Organization
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Legal Business Name | COMPCARE, LLC
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 04/05/2020
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Provider Practice Location Address
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Address Line | 94-997 HANAUNA ST 5F
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City | WAIPAHU
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State | HI
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Zip | 96797
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Country | US
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Telephone | 850-694-9864
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Fax | 850-270-2452
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Provider Business Mailing Address
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Address Line | 1130 SCHWALL ROAD
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City | HAVANA
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State | FL
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Zip | 32333
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Country | US
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Telephone | 850-694-9864
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO/ARNP
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Name | ORETHA DIANE JONES
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Credential | ARNP
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Telephone | 850-694-9864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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