Organization
CD EAST FAMILY HEALTH & WELLNESS CENTER LLC
Active
Other names
CD East Family Health & Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELIQUE MCKINNEY-BOURNE M.D. (PHYSICIAN/OWNER)
(717) 695-3704
Entity
Organization
Contact information
Practice address
845 SIR THOMAS CT, SUITE 5, HARRISBURG, PA 17109-4840
(717) 695-3704
(717) 695-7735
Mailing address
845 SIR THOMAS CT, SUITE 5, HARRISBURG, PA 17109-4840
(717) 695-3704
(717) 695-7735
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD418042
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01784747
—
PA
01
—
1942306162
OWNER PERSONAL NPI
PA
Enumeration date
10/19/2009
Last updated
05/26/2010
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