Provider Demographics
NPI:1700412814
Name:PARTNERS IN COMMUNITY CARE, LLC
Entity Type:Organization
Organization Name:PARTNERS IN COMMUNITY CARE, LLC
Other - Org Name:BREVARDPICC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ALISE
Authorized Official - Last Name:WEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-243-7060
Mailing Address - Street 1:4154 SAN YSIDRO WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5336
Mailing Address - Country:US
Mailing Address - Phone:321-241-6244
Mailing Address - Fax:833-301-0862
Practice Address - Street 1:4154 SAN YSIDRO WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5336
Practice Address - Country:US
Practice Address - Phone:321-241-6244
Practice Address - Fax:833-301-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care