NPIMap

Organization Active NPI

Prospect CCMC, LLC

  • Clinic/Center
  • Chester, PA
National Provider Identifier
1376990366
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROSPECT CCMC, LLC
Practice address
301 W 15TH St
Chester, PA 19013
Phone
(610) 619-8600
NPI assigned
May 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

301 W 15TH St
Chester, PA 19013

Mailing address

301 W 15TH St
Chester, PA 19013-5300
Phone (610) 619-8600

Other practice location 1

310 W 15th St
Chester, PA 19013-5316
Phone (610) 447-2040

Other names 1

  • Drug & Alcohol Outpatient Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1376990366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W 15TH ST",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190135300",
            "telephone_number": "610-619-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W 15TH ST",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "19013",
            "telephone_number": "610-619-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 W 15th St",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "PA",
            "postal_code": "190135316",
            "country_code": "US",
            "telephone_number": "610-447-2040",
            "fax_number": "610-447-6620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROSPECT CCMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-19",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drug & Alcohol Outpatient",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Drug & Alcohol Outpatient",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.