Organization
WYNGATE PRIMARY ARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE CONNER (PRESIDENT)
(267) 367-2818
Entity
Organization
Contact information
Practice address
110 BLACK HORSE ALY, PHILADELPHIA, PA 19106-3121
(267) 367-2818
Mailing address
110 BLACK HORSE ALY, PHILADELPHIA, PA 19106-3121
(267) 367-2818
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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