MEDICARE: DOMINION HEALTHCARE CLINIC 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1699579581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION HEALTHCARE CLINIC LLC

Provider Business Mailing Address
First Line	:	208 BANTRY ST
Second Line	:
City	:	SWEDESBORO
State	:	NJ
Zip	:	08085-3190
Country	:	US
Telephone Number	:	484-402-0166
Fax Number	:	856-935-9123

Provider Business Practice Location Address
First Line	:	6536 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2215
Country	:	US
Telephone Number	:	484-402-1660
Fax Number	:	856-935-9123

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	BERNADETT ALFRED
Credential	:	APN
Telephone Number	:	484-402-0166

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	11/18/2025

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Directions to “DOMINION HEALTHCARE CLINIC LLC ” Practice Location

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