Provider Demographics
NPI:1568157212
Name:ESSENTIAL CARE CLINIC LLC
Entity Type:Organization
Organization Name:ESSENTIAL CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:240-247-0791
Mailing Address - Street 1:6507 OLD BRANCH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2628
Mailing Address - Country:US
Mailing Address - Phone:240-247-0791
Mailing Address - Fax:
Practice Address - Street 1:6507 OLD BRANCH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2628
Practice Address - Country:US
Practice Address - Phone:240-247-0791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty