MEDICARE: PREVENTIVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1609505726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE CARE LLC

Provider Business Mailing Address
First Line	:	14839 231ST ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-4244
Country	:	US
Telephone Number	:	718-781-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	14839 231ST ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-4244
Country	:	US
Telephone Number	:	718-781-6373
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH GINO LOUIS
Credential	:
Telephone Number	:	718-781-6373

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	09/30/2022

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