Provider Demographics
NPI:1114474459
Name:COMPLETE CARE COORDINATION AGENCY
Entity Type:Organization
Organization Name:COMPLETE CARE COORDINATION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIDOR-DORSAINVIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-668-5769
Mailing Address - Street 1:6324 SHELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5615
Mailing Address - Country:US
Mailing Address - Phone:215-668-5769
Mailing Address - Fax:
Practice Address - Street 1:6324 SHELBOURNE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-5615
Practice Address - Country:US
Practice Address - Phone:215-668-5769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE CARE COORDINATION AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization