Provider Demographics
NPI:1164144135
Name:VILLAGE PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:VILLAGE PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, ANP-BC
Authorized Official - Phone:508-331-3987
Mailing Address - Street 1:200 W CENTER ST STE C3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4870
Mailing Address - Country:US
Mailing Address - Phone:508-331-3987
Mailing Address - Fax:
Practice Address - Street 1:200 W CENTER ST STE C3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4870
Practice Address - Country:US
Practice Address - Phone:508-331-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty