Provider Demographics
NPI:1891324471
Name:COMPCARE, LLC
Entity Type:Organization
Organization Name:COMPCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/ARNP
Authorized Official - Prefix:
Authorized Official - First Name:ORETHA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-694-9864
Mailing Address - Street 1:1130 SCHWALL ROAD
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333
Mailing Address - Country:US
Mailing Address - Phone:850-694-9864
Mailing Address - Fax:
Practice Address - Street 1:94-997 HANAUNA ST 5F
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:850-694-9864
Practice Address - Fax:850-270-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care