# PROSPECT CCMC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326492463
- **Authorized official:** ROBERT JON ELDERS (SECRETARY)
- **Authorized official phone:** (714) 788-1249

## Contact information

- **Practice address:** 2600 W 9TH ST, CHESTER, PA 19013-2040
- **Practice address phone:** (610) 497-7344
- **Practice address fax:** (610) 497-7472
- **Mailing address:** 2600 W 9TH ST, CHESTER, PA 19013-2040
- **Mailing address phone:** (610) 497-7344
- **Mailing address fax:** (610) 497-7472

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WC1500X | Community Health Registered Nurse | — | NULL | Yes |
| 163WC1500X | Community Health Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 04/14/2016
- **Last updated:** 01/15/2021