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Organization
PROSPECT CCMC, LLC
Active
Organization
PROSPECT CCMC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
2600 W 9TH ST, CHESTER, PA 19013-2040
(610) 497-7344
(610) 497-7472
Mailing address
2600 W 9TH ST, CHESTER, PA 19013-2040
(610) 497-7344
(610) 497-7472
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
—
NULL
163WC1500X
Community Health Registered Nurse
Primary
—
—
Other
Enumeration date
04/14/2016
Last updated
01/15/2021
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